Individual
MR. MARK DOMINICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
521 LANCASTER AVE, MOBERLY BUILDING, RICHMOND, KY 40475-3100
(207) 272-6819
Mailing address
113 CHESTNUT DR, APARTMENT #3, RICHMOND, KY 40475-7835
(207) 272-6819
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
KY
Other
Enumeration date
08/24/2014
Last updated
08/24/2014
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