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Individual

BLAINE DOMANN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
515 DAWSON ST, EASTON, KS 66020-9200
(615) 896-6400
Mailing address
410 MAPLE CT, LANSING, KS 66043-2231
(913) 351-3125

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
14-00710
KS

Other

Enumeration date
06/01/2007
Last updated
07/08/2007
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