Provider Demographics
NPI:1821214594
Name:COMEROUSKI, JOHN T (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:COMEROUSKI
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 1:5 N. 425 EAGLE TERRACE
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143
Mailing Address - Country:US
Mailing Address - Phone:630-250-8969
Mailing Address - Fax:
Practice Address - Street 1:818 OAK CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-268-1045
Practice Address - Fax:630-268-1047
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070003076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8855Medicare UPIN