Provider Demographics
NPI:1659022903
Name:SUMRALL, A'OUMONTYE ZOUWYILLE (LAT, ATC, CES)
Entity Type:Individual
Prefix:
First Name:A'OUMONTYE
Middle Name:ZOUWYILLE
Last Name:SUMRALL
Suffix:
Gender:M
Credentials:LAT, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 BUTTERFLY DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-7918
Mailing Address - Country:US
Mailing Address - Phone:281-414-8454
Mailing Address - Fax:
Practice Address - Street 1:805 SAGE BRUSH
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-3747
Practice Address - Country:US
Practice Address - Phone:281-414-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT76982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer