Provider Demographics
NPI:1447547799
Name:DOMINGUEZ, ANDREW (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8335 AGORA PKWY # 100
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1383
Mailing Address - Country:US
Mailing Address - Phone:210-658-8483
Mailing Address - Fax:
Practice Address - Street 1:8335 AGORA PKWY # 100
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-1383
Practice Address - Country:US
Practice Address - Phone:210-658-8483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12075962251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic