Provider Demographics
NPI:1073639571
Name:KOMNICK, ELIZABETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:KOMNICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:SAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2300 N. EDWARD ST.
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526
Mailing Address - Country:US
Mailing Address - Phone:217-876-2600
Mailing Address - Fax:217-876-2615
Practice Address - Street 1:2300 N. EDWARD ST.
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526
Practice Address - Country:US
Practice Address - Phone:217-876-2600
Practice Address - Fax:217-876-2615
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014618225100000X
IL070.014618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
113326OtherHEALTHLINK PROV ID
IL4117OtherHAMP PROV ID
IL203OtherBLUE CROSS PROV ID
7216OtherPERSONALCARE PROV ID
140091Medicare ID - Type Unspecified