Provider Demographics
NPI:1235910142
Name:COMELLO, MICHAEL A (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:COMELLO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4118 11TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33976-2712
Mailing Address - Country:US
Mailing Address - Phone:479-206-3774
Mailing Address - Fax:
Practice Address - Street 1:17011 ALICO COMMERCE CT STE 507
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33967-2540
Practice Address - Country:US
Practice Address - Phone:239-829-8393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist