Provider Demographics
NPI:1225678634
Name:PUMMILL, SCOTT W
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:PUMMILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 WHITE MARSH LN
Mailing Address - Street 2:
Mailing Address - City:ROTONDA WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33947-2180
Mailing Address - Country:US
Mailing Address - Phone:734-679-7133
Mailing Address - Fax:
Practice Address - Street 1:250 VENICE GOLF CLUB DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3146
Practice Address - Country:US
Practice Address - Phone:734-679-7133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019451225100000X
FL38196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist