Provider Demographics
NPI:1013554674
Name:KOMROWER, MICHELLE RENEE (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:KOMROWER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 RIDGEBROOK RD STE 330
Mailing Address - Street 2:
Mailing Address - City:SPARKS GLENCOE
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9440
Mailing Address - Country:US
Mailing Address - Phone:443-212-5745
Mailing Address - Fax:443-212-5749
Practice Address - Street 1:954 RIDGEBROOK RD STE 330
Practice Address - Street 2:
Practice Address - City:SPARKS GLENCOE
Practice Address - State:MD
Practice Address - Zip Code:21152-9440
Practice Address - Country:US
Practice Address - Phone:443-212-5745
Practice Address - Fax:443-212-5749
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist