Active NPI
Patrick J Domanico, PT
- Physical Therapist
- Peoria, AZ
National Provider Identifier
1710966767
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 0495
- Practice address
- 13660 N 94TH Dr
Suite B2
Peoria, AZ 85381-4836 - Phone
- (623) 977-4233
- Fax
- (623) 977-0259
- NPI assigned
- Jan 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 0495 | AZ | Primary |
Addresses
Primary practice location
13660 N 94TH Dr
Suite B2
Peoria, AZ 85381-4836
Mailing address
6720 W Wahalla LN
Glendale, AZ 85308-5579
Phone (623) 977-4233
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 495 | AZ | MD | Foot Surgery Podiatrist |
| 0495 | AZ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526601600000",
"number": "1710966767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6720 W WAHALLA LN",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853085579",
"telephone_number": "623-977-4233",
"fax_number": "623-977-0259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13660 N 94TH DR",
"address_2": "SUITE B2",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853814836",
"telephone_number": "623-977-4233",
"fax_number": "623-977-0259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMANICO",
"first_name": "PATRICK",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-10",
"last_updated": "2018-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "0495",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.