Provider Demographics
NPI:1235991803
Name:SCOTT PUMMILL PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:SCOTT PUMMILL PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:PUMMILL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:734-679-7133
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy