Individual
MR. MARTIN HENNINGER DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2820 WATERFORD LAKE DR STE 103, MIDLOTHIAN, VA 23112-3994
(804) 249-8277
(804) 249-9690
Mailing address
3200 LADY MARIAN LN, MIDLOTHIAN, VA 23113-1178
(804) 677-2551
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
2305004476
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010356393
—
VA
Enumeration date
07/20/2005
Last updated
08/02/2022
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