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General NPI Number Information
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NPI Number | 1205506912
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Entity Type | Individual
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Provider Name | THEODORE WILLIAM HOMOL III PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 4275 SCHOOL HOUSE CMNS
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City | HARRISBURG
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State | NC
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Zip | 28075-7503
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Country | US
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Telephone | 980-326-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 CORPORATE DR STE 400
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City | HOOVER
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State | AL
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Zip | 35242-5424
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Country | US
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Telephone | 423-238-7217
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 28688
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P21412
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 10839
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License Number State | SC
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