| Doctor Name: | DOMINIQUE MADELEINE KOHLENBERGER |
| NPI Number: | 1992075279 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | PT 7196 |
| Business Practice Address: | 4134 Gulf Of Mexico Dr Unit 209 Longboat Key, FL - 342282642 |
| Business Phone Number: | 9413830414 |
| Business Fax Number: | 9413830120 |
| Mailing Address: | Po Box 1156, ELLENTON |
| State: | FL |
| Postal Code: | 342221156 |
| Phone Number: | 9417290003 |
| Fax Number: | 9417290004 |
| NPI Enumeration Date: | 01/04/2012 |
| NPI Last Update Date: | 01/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT 7196 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |