Provider Demographics
NPI:1013037720
Name:ALTRU PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:ALTRU PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOMOROSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-387-1007
Mailing Address - Street 1:4125 WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1847
Mailing Address - Country:US
Mailing Address - Phone:724-386-1007
Mailing Address - Fax:724-387-1009
Practice Address - Street 1:4125 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1847
Practice Address - Country:US
Practice Address - Phone:724-386-1007
Practice Address - Fax:724-387-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPTO5422L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1962437889OtherNPI GREGORY KOMOROSKI PT
PARI1742951OtherBC IDENTIFICATION #
PA515166OtherPROVIDER BC ID #
PA1033141452OtherNPI MICHAEL RICCHIUTO MPT
PA081806Medicare ID - Type Unspecified