Individual
TIM D DOMINICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1400 JOHNSTON WILLIS DR STE A, NORTH CHESTERFIELD, VA 23235-4765
(804) 379-8088
Mailing address
1115 BOULDERS PKWY STE 200, NORTH CHESTERFIELD, VA 23225-4067
(804) 560-5595
(804) 560-9029
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2085
NC
363A00000X
Physician Assistant
Primary
0110-006707
VA
Other
Enumeration date
03/25/2014
Last updated
06/08/2020
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