Provider Demographics
NPI:1437670064
Name:GREGORY L KOMOROSKI PT LLC
Entity Type:Organization
Organization Name:GREGORY L KOMOROSKI PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOMOROSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-424-4914
Mailing Address - Street 1:1514 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5448
Mailing Address - Country:US
Mailing Address - Phone:724-424-4914
Mailing Address - Fax:724-424-9822
Practice Address - Street 1:PO BOX 307
Practice Address - Street 2:
Practice Address - City:NORVELT
Practice Address - State:PA
Practice Address - Zip Code:15674-0307
Practice Address - Country:US
Practice Address - Phone:724-424-4914
Practice Address - Fax:724-424-9822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-05
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT000573208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty