Provider Demographics
NPI:1619950334
Name:COMER, ELAINE S (PT)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:S
Last Name:COMER
Suffix:
Gender:F
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:PO BOX 5982
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23471-0982
Mailing Address - Country:US
Mailing Address - Phone:757-547-7554
Mailing Address - Fax:757-548-0647
Practice Address - Street 1:637 KINGSBOROUGH SQ
Practice Address - Street 2:SUITES F&G
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4944
Practice Address - Country:US
Practice Address - Phone:757-754-7755
Practice Address - Fax:757-548-0647
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050003032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010380405Medicaid
VA010380448Medicaid
VA008938806Medicaid
VA010380383Medicaid
VA010381142Medicaid
VA650000264Medicare PIN