Individual
GREGG EDWARD DEDOMENICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, MS, ATC
Contact information
Practice address
208 N DUPONT BLVD, SMYRNA, DE 19977-1511
(302) 539-8389
Mailing address
110 CARTAGENA DR, BRICK, NJ 08723-7005
(347) 609-3038
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
J1-0014325
DE
Other
Enumeration date
03/19/2021
Last updated
03/19/2021
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