NPIMap

Organization Active NPI

Dominiczak Therapy Associates, LLC

  • Physical Therapist
  • Brown Deer, WI
National Provider Identifier
1730327073
Registry record updated Jan 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2714-024 Issued in WI
Legal business name
DOMINICZAK THERAPY ASSOCIATES, LLC
Practice address
4002 W Cherrywood LN
Brown Deer, WI 53209-1002
Phone
(414) 378-3375
NPI assigned
Jan 24, 2009
Last updated
Jan 24, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lori DominiczakNPI 1548450372
Title
Manager
Phone
(414) 378-3375

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2714-024 WI Primary

Addresses

Primary practice location

4002 W Cherrywood LN
Brown Deer, WI 53209-1002

Mailing address

4002 W Cherrywood LN
Brown Deer, WI 53209-1002

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1232755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232755200000",
    "number": "1730327073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4002 W CHERRYWOOD LN",
            "city": "BROWN DEER",
            "state": "WI",
            "postal_code": "532091002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4002 W CHERRYWOOD LN",
            "city": "BROWN DEER",
            "state": "WI",
            "postal_code": "532091002",
            "telephone_number": "414-378-3375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINICZAK THERAPY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-24",
        "last_updated": "2009-01-24",
        "status": "A",
        "authorized_official_last_name": "DOMINICZAK",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "414-378-3375"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "2714-024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brown Deer, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.