DOMINIQUE JORDAN RIVERA WILLIAMS (DPT) – Physical Therapist, NPI 1104643030

DOMINIQUE JORDAN RIVERA WILLIAMS (DPT) is a healthcare provider. based in Boynton beach, Florida. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials DPT. They hold a License No. PT42299 (FL). The NPI Number for DOMINIQUE JORDAN RIVERA WILLIAMS (DPT) is 1104643030

Main info

Male
3 Years Of Experience
Accepts Medicare Assignment
Name
DOMINIQUE JORDAN RIVERA WILLIAMS (DPT)
NPI
1104643030
Phone
(561) 432-0111
Address
1903 S CONGRESS AVE STE 100
Enumeration Date
23 September 2024
Last Update Date
18 October 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5614320111
Graduation Year
2023 (3 years ago)
PAC ID
0547791907
Group Practice PAC ID
1052306271
Professional Enrollment ID
I20241009002492
Address ID
FL334266553BO1903XAVEX401
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness75
Years active:1State licenses:1Digital endpointsOther names

4,633 PHYSICAL THERAPIST IN PRIVATE PRACTICE in FL

Provider Addresses for DOMINIQUE JORDAN RIVERA WILLIAMS (DPT)

  • 1903 S CONGRESS AVE STE 100

    BOYNTON BEACH, FL 334266553

    Phone: (561) 432-0111

    Fax: (561) 432-1075

    Type: Location

  • 5840 CORPORATE WAY STE 101

    WEST PALM BEACH, FL 334072040

    Phone: (561) 432-0111

    Fax: (561) 432-1075

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-10-09

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20241009002492IPhysical Therapist In Private PracticeFLTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 33426)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1052306271View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeFL
-FL
-WV
Physical Therapist In Private PracticeFL
Physical Therapist In Private PracticeFL
Occupational Therapist In Private PracticeIL
Physical Therapist In Private PracticeTX
-FL
Physical Therapist In Private PracticeFL
Occupational Therapist In Private PracticeFL

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Frequently asked questions

Can I verify DOMINIQUE JORDAN RIVERA WILLIAMS (DPT) with an NPI only?
You can start verification with NPI 1104643030 for DOMINIQUE JORDAN RIVERA WILLIAMS (DPT), then check state licensing separately.
Does the file indicate DOMINIQUE JORDAN RIVERA WILLIAMS (DPT) is practicing under active NPI?
Directory data currently reports DOMINIQUE JORDAN RIVERA WILLIAMS (DPT) as active.
What is DOMINIQUE JORDAN RIVERA WILLIAMS (DPT)'s primary classification?
Physical Therapist is the headline specialty for DOMINIQUE JORDAN RIVERA WILLIAMS (DPT) here. Clinical services aligned with this taxonomy classification.
What area does DOMINIQUE JORDAN RIVERA WILLIAMS (DPT) serve?
DOMINIQUE JORDAN RIVERA WILLIAMS (DPT)'s listing highlights Boynton Beach, Florida; more addresses can appear in NPPES.
Is the information about DOMINIQUE JORDAN RIVERA WILLIAMS (DPT) up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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