Provider Demographics
NPI:1497065296
Name:GOMMEL, ERNEST ROBERT JR (PT)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:ROBERT
Last Name:GOMMEL
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 TIDWELL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34291-4103
Mailing Address - Country:US
Mailing Address - Phone:941-661-8632
Mailing Address - Fax:941-343-9402
Practice Address - Street 1:5968 CLARK CENTER AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-2715
Practice Address - Country:US
Practice Address - Phone:941-922-8200
Practice Address - Fax:941-343-9402
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist