Individual
TIMOTHY ROBERT DOMINICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.T.
Contact information
Practice address
16770 SW EDY RD STE 310, SHERWOOD, OR 97140-9679
(503) 216-9731
(503) 216-9732
Mailing address
16310 SW PALERMO LN, TIGARD, OR 97223-0692
(503) 577-0942
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
26238
CA
225100000X
Physical Therapist
Primary
5149
OR
2251X0800X
Orthopedic Physical Therapist
5149
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5628499
FIRST HEALTH
CA
01
—
ZZZ01897Z
BLUE SHIELD
CA
Enumeration date
08/09/2005
Last updated
08/06/2024
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