Healthcare Provider Details

I. General information

NPI: 1417560848
Provider Name (Legal Business Name): DANIEL WILLIAM KOMFORTI PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date: 01/08/2023
Reactivation Date: 01/30/2023

III. Provider practice location address

15504 STONEYBROOK WEST PKWY STE 110
WINTER GARDEN FL
34787-4768
US

IV. Provider business mailing address

211 RUSKIN ST
LAKE MARY FL
32746-3513
US

V. Phone/Fax

Practice location:
  • Phone: 407-476-6613
  • Fax:
Mailing address:
  • Phone: 646-753-3106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT36172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: