Individual
MRS. ELIZABETH KOMNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
2300 N. EDWARD ST., DECATUR, IL 62526
(217) 876-2600
(217) 876-2615
Mailing address
2300 N. EDWARD ST., DECATUR, IL 62526
(217) 876-2600
(217) 876-2615
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070.014618
IL
225100000X
Physical Therapist
070014618
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113326
HEALTHLINK PROV ID
—
01
—
203
BLUE CROSS PROV ID
IL
01
—
4117
HAMP PROV ID
IL
01
—
7216
PERSONALCARE PROV ID
—
Enumeration date
03/22/2007
Last updated
11/26/2008
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