Provider Demographics
NPI:1255344230
Name:HUMPAL, SCOTT A (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:HUMPAL
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5026 DEEPWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-2901
Mailing Address - Country:US
Mailing Address - Phone:361-854-2278
Mailing Address - Fax:361-854-2389
Practice Address - Street 1:5026 DEEPWOOD CIR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-2901
Practice Address - Country:US
Practice Address - Phone:361-854-2278
Practice Address - Fax:361-854-2389
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1054435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650008979OtherMEDICARE RAILROAD
TX80834TOtherBLUE CROSS BLUE SHIELD
TX1427403-01Medicaid
TX83467EMedicare ID - Type UnspecifiedIND MEDICARE PROVIDER NUM