Healthcare Provider Details

I. General information

NPI: 1386574309
Provider Name (Legal Business Name): AUSTIN KOMOROWSKI PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: AJ KOMOROWSKI PT, DPT

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 N MAYFAIR RD
MILWAUKEE WI
53222-4306
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-479-3737
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17692-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: