Provider Demographics
NPI:1578752945
Name:POMPILE, DOMENIC J (PT,CSCS)
Entity Type:Individual
Prefix:MR
First Name:DOMENIC
Middle Name:J
Last Name:POMPILE
Suffix:
Gender:M
Credentials:PT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3416 S FEDERAL HWY
Mailing Address - Street 2:VADO THERAPY
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3227
Mailing Address - Country:US
Mailing Address - Phone:561-450-6487
Mailing Address - Fax:561-450-6526
Practice Address - Street 1:3416 S FEDERAL HWY
Practice Address - Street 2:VADO THERAPY
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3227
Practice Address - Country:US
Practice Address - Phone:561-450-6487
Practice Address - Fax:561-450-6526
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL018160174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFM007AOtherMEDICARE PTAN