Provider Demographics
NPI:1417560848
Name:KOMFORTI, DANIEL WILLIAM (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WILLIAM
Last Name:KOMFORTI
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 1:211 RUSKIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3513
Mailing Address - Country:US
Mailing Address - Phone:646-753-3106
Mailing Address - Fax:
Practice Address - Street 1:211 RUSKIN ST
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3513
Practice Address - Country:US
Practice Address - Phone:646-753-3106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2023-02-12
Deactivation Date:2023-01-08
Deactivation Code:
Reactivation Date:2023-01-30
Provider Licenses
StateLicense IDTaxonomies
FLPT36172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist