Individual
DIANNE DOMST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
411 S LASALLE ST, DURHAM, NC 27705-3701
(191) 938-3552
Mailing address
5200 SUMMIT MANOR LN, APT 409, RALEIGH, NC 27613-7067
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A3792
NC
Other
Enumeration date
05/14/2008
Last updated
05/14/2008
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