Provider Demographics
NPI:1407336969
Name:MCCOMISKEY, SEAN VINCENT (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:VINCENT
Last Name:MCCOMISKEY
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 1:611 S PACA ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-2411
Mailing Address - Country:US
Mailing Address - Phone:443-977-4470
Mailing Address - Fax:443-687-8684
Practice Address - Street 1:2000 GIRARD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1595
Practice Address - Country:US
Practice Address - Phone:443-977-4470
Practice Address - Fax:443-687-8684
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist