Healthcare Provider Details

I. General information

NPI: 1245353994
Provider Name (Legal Business Name): LAURA KOMISAR PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 PLEASANT ST
CONCORD NH
03301-7504
US

IV. Provider business mailing address

3 LANTERN LN
AUBURN NH
03032-3736
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-6561
  • Fax:
Mailing address:
  • Phone: 603-647-6579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0323
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: