Provider Demographics
NPI:1730575713
Name:KOMMER, NANCY (PTA)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:KOMMER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WOODSEDGE DR APT 2A
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-4280
Mailing Address - Country:US
Mailing Address - Phone:860-665-9730
Mailing Address - Fax:
Practice Address - Street 1:59 HARRINGTON CT
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1207
Practice Address - Country:US
Practice Address - Phone:860-537-2339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT285225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant