Adam Wyatt Pennell, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT21843 Issued in FL

Practice address

4130 Tamiami TRL Ste 2
Port Charlotte, FL 33952-9207

Phone

(844) 287-4101

Fax

(941) 833-4101

NPI assigned

Dec 21, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• Direct secure messaging: adam.pennell.1@4290.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Millennium Physician Group LLC

  • Family Medicine Physician
  • Brooksville, FL
  • NPI 1073131702
  NPD
• Millennium Physician Group LLC

  • Family Medicine Physician
  • Fort Myers, FL
  • NPI 1811122880
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703635200000",
    "number": "1609930619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "877-856-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4130 TAMIAMI TRL STE 2",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339529207",
            "telephone_number": "844-287-4101",
            "fax_number": "941-833-4101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 Pine St",
            "address_2": "Suite 127",
            "address_purpose": "LOCATION",
            "city": "Englewood",
            "state": "FL",
            "postal_code": "342234418",
            "country_code": "US",
            "telephone_number": "941-475-2022",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENNELL",
        "first_name": "ADAM",
        "middle_name": "WYATT",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-21",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT21843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander Pedraza
• Margaret A Pedraza
• Tyffanie Pellegrino
• Victor Manuel Pena, M.D.
• Farah Penel, APRN
• Jacob Pennington, D.O.
• Anis Laura Peralta, RBT
• Ivor John Percent, M.D.
• Yelissa Perez Alvarez
• Daniel Alejandro Perez Armenteros

• Physical Therapist in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.