Healthcare Provider Details

I. General information

NPI: 1366498701
Provider Name (Legal Business Name): DEANNA MARIE MCCOMISH L.A.T.C, P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 ORCHARD CENTRE DR
HOLLAND OH
43528-7974
US

IV. Provider business mailing address

7117 ORCHARD CENTRE DR
HOLLAND OH
43528-7974
US

V. Phone/Fax

Practice location:
  • Phone: 419-866-9675
  • Fax: 419-866-5716
Mailing address:
  • Phone: 419-866-9675
  • Fax: 419-866-5716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-4112
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License NumberPT-4112
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT-4112
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT-4112
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-96
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: