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Individual
THEODORE WILLIAM HOMOL III
Active
Individual
THEODORE WILLIAM HOMOL III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
10839
SC
225100000X
Physical Therapist
28688
MD
225100000X
Physical Therapist
Primary
P21412
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10839
PHYSICAL THERAPY LICENSE
SC
Enumeration date
09/14/2021
Last updated
11/13/2024
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