Individual
LORI DOMINICZAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4002 W CHERRYWOOD LN, BROWN DEER, WI 53209-1002
(414) 378-3375
Mailing address
4002 W CHERRYWOOD LN, BROWN DEER, WI 53209-1002
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
2714-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40440700
—
WI
Enumeration date
07/27/2007
Last updated
07/27/2007
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