Provider Demographics
NPI:1518791581
Name:KOMOROWSKI, JENNIFER CRINITI
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CRINITI
Last Name:KOMOROWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-1448
Mailing Address - Country:US
Mailing Address - Phone:304-281-9039
Mailing Address - Fax:
Practice Address - Street 1:69 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-1448
Practice Address - Country:US
Practice Address - Phone:304-281-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV0019682251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics