Provider Demographics
NPI:1730863424
Name:DIPRINZIO, DOMINIC JOSEPH (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:JOSEPH
Last Name:DIPRINZIO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 S WARREN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2731
Mailing Address - Country:US
Mailing Address - Phone:703-201-9149
Mailing Address - Fax:
Practice Address - Street 1:8390 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1002
Practice Address - Country:US
Practice Address - Phone:315-652-4323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist