Individual
ANDREA DOMINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
7224 118TH AVE, STE E, KENOSHA, WI 53142-8424
(262) 857-4400
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12648-24
WI
Other
Enumeration date
06/06/2014
Last updated
02/09/2016
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