1023202603 NPI number — MRS. LYNN ELIZABETH KOMAR MSPT

Table of content: MRS. LYNN ELIZABETH KOMAR MSPT (NPI 1023202603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023202603 NPI number — MRS. LYNN ELIZABETH KOMAR MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOMAR
Provider First Name:
LYNN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023202603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3666 KEARNY VILLA RD STE 200
Provider Second Line Business Mailing Address:
SHARP REES STEALY PHYSICAL THERAPY
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-1951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-505-5400
Provider Business Mailing Address Fax Number:
858-505-5459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3666 KEARNY VILLA RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-505-5400
Provider Business Practice Location Address Fax Number:
858-505-5459
Provider Enumeration Date:
08/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT18531 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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