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General NPI Number Information
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NPI Number | 1821214594
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Entity Type | Individual
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Provider Name | JOHN T. COMEROUSKI PT
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 01/05/2016
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Provider Practice Location Address
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Address Line | 818 OAK CREEK DRIVE
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City | LOMBARD
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State | IL
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Zip | 60148
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Country | US
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Telephone | 630-268-1045
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Fax | 630-268-1047
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Provider Business Mailing Address
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Address Line | 5 N. 425 EAGLE TERRACE
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City | ITASCA
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State | IL
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Zip | 60143
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Country | US
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Telephone | 630-250-8969
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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 | 070003076
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License Number State | IL
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