Healthcare Provider Details

I. General information

NPI: 1346355641
Provider Name (Legal Business Name): SCOTT DAVID TOMMOLA MS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 BUSINESS ROUTE 4 SUITE 3
CENTER RUTLAND VT
05736-9731
US

IV. Provider business mailing address

279 BUSINESS ROUTE 4 SUITE 3
CENTER RUTLAND VT
05736-9731
US

V. Phone/Fax

Practice location:
  • Phone: 802-773-8600
  • Fax: 802-773-2200
Mailing address:
  • Phone: 802-773-8600
  • Fax: 802-773-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040-0003188
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: