Provider Demographics
NPI:1003025487
Name:KOMOCAR, LORETTA J (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:J
Last Name:KOMOCAR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6854 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5022
Mailing Address - Country:US
Mailing Address - Phone:954-491-2225
Mailing Address - Fax:
Practice Address - Street 1:HOLISTIC MASSAGE & WELLNESS CLINIC
Practice Address - Street 2:903 CYPRESS CREEK
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334
Practice Address - Country:US
Practice Address - Phone:954-941-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist