Provider Demographics
NPI:1821666025
Name:COMIA, RHIANNON (DPT)
Entity Type:Individual
Prefix:
First Name:RHIANNON
Middle Name:
Last Name:COMIA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 N IMPERIAL AVE STE H
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-3209
Mailing Address - Country:US
Mailing Address - Phone:760-890-7050
Mailing Address - Fax:
Practice Address - Street 1:2300 N IMPERIAL AVE STE H
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-3209
Practice Address - Country:US
Practice Address - Phone:760-890-7050
Practice Address - Fax:877-298-4204
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT300305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist