IndividualActive
Ivan Domenech
NPI 1386972867 · Physical Therapy Assistant · Southern Pines, NC
Provider details
- NPI number
- 1386972867
- Entity type
- Individual
- Primary specialty
- Physical Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Sex
- Male
- Sole proprietor
- No
- License
- 4278 (NC)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Profile Score
Detailed profile(84/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
16 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
103 Gossman Rd
Southern Pines, NC 28387-2225
Phone: (910) 246-1158
Street-level locationGet directions
Mailing address
55 Blue Pine Dr
Spring Lake, NC 28390-9176
Registry dates
- Enumerated
- 2009-11-23
- Last updated
- 2009-11-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.