Provider Demographics
NPI:1003236951
Name:COMEROUSKI, CHRISTEL (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTEL
Middle Name:
Last Name:COMEROUSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 OAK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6405
Mailing Address - Country:US
Mailing Address - Phone:630-268-1045
Mailing Address - Fax:630-268-1047
Practice Address - Street 1:818 OAK CREEK DR
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6405
Practice Address - Country:US
Practice Address - Phone:630-268-1045
Practice Address - Fax:630-268-1047
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070003099208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL8855Medicare PIN