Provider Demographics
NPI:1467730820
Name:KOMISARSKI, BRIAN ARTHUR (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ARTHUR
Last Name:KOMISARSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-1641
Mailing Address - Country:US
Mailing Address - Phone:814-451-1334
Mailing Address - Fax:814-480-5843
Practice Address - Street 1:607 E 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-2813
Practice Address - Country:US
Practice Address - Phone:814-451-1334
Practice Address - Fax:814-480-5843
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012351L2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics