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General NPI Number Information
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NPI Number | 1609153451
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Entity Type | Individual
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Provider Name | MICHELE CZUCHAN KOMARA PT
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Gender | Female
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 107 CRAFT ST
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City | BROWNSVILLE
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State | PA
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Zip | 15417-9685
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Country | US
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Telephone | 773-403-4707
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Fax |
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Provider Business Mailing Address
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Address Line | 107 CRAFT ST
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City | BROWNSVILLE
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State | PA
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Zip | 15417-9685
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Country | US
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Telephone | 773-403-4707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT007071L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT003711
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT27207
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1225853
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.009406
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License Number State | IL
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