Provider Demographics
NPI:1154677979
Name:KOMOROSKE, EMILY (PT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:KOMOROSKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:ROSSINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5330 CENTURY AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2007
Mailing Address - Country:US
Mailing Address - Phone:608-203-8880
Mailing Address - Fax:608-203-8881
Practice Address - Street 1:5330 CENTURY AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-2007
Practice Address - Country:US
Practice Address - Phone:608-203-8880
Practice Address - Fax:608-203-8881
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11826-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100026609Medicaid