Provider Demographics
NPI:1346355641
Name:TOMMOLA, SCOTT DAVID (MS PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:TOMMOLA
Suffix:
Gender:M
Credentials:MS PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:279 BUSINESS ROUTE 4
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CENTER RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05736-9731
Mailing Address - Country:US
Mailing Address - Phone:802-773-8600
Mailing Address - Fax:802-773-2200
Practice Address - Street 1:279 BUSINESS ROUTE 4
Practice Address - Street 2:SUITE 3
Practice Address - City:CENTER RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05736-9731
Practice Address - Country:US
Practice Address - Phone:802-773-8600
Practice Address - Fax:802-773-2200
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT040-0003188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTTX7217Medicare PIN
VTVN2579Medicare UPIN