Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 044453 | NY |
NPI | 1003272774 |
---|---|
Provider Name | Thomas L Komor |
First Address | Binghamton, NY 13905-1040 |
Second Address | Vestal, NY 13850-3556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2016 |
Last Update Date | 05/06/2020 |