Individual
MS. MARYANN THERESA DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
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) 677-6786
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305004526
VA
Other
Enumeration date
07/15/2005
Last updated
08/02/2022
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