Individual
MR. DOMONIQUE L HARDMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2076 SW FALLON LN, LAKE CITY, FL 32025-1314
(386) 344-9095
Mailing address
2076 SW FALLON LN, LAKE CITY, FL 32025-1314
(386) 344-9095
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA28905
FL
Other
Enumeration date
10/16/2018
Last updated
10/16/2018
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