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NPI Code Detail

MEDICARE: DR. MICHAEL COMMESSO PT, DPT

MEDICARE: DR. MICHAEL COMMESSO PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistP17318NC

General Provider Information

NPI Number : 1477078012
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL COMMESSO PT, DPT
Provider Business Mailing Address
First Line : 1122 PROSPECT AVE
Second Line :
City : SAN GABRIEL
State : CA
Zip : 91776-2933
Country : US
Telephone Number : 631-708-4969
Fax Number :
Provider Business Practice Location Address
First Line : 99 PASADENA AVE STE 10C
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-6142
Country : US
Telephone Number : 323-341-5580
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2017
Last Update Date : 09/28/2022

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Directions to “ DR. MICHAEL COMMESSO PT, DPT” Practice Location

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