Provider Demographics
NPI:1063748051
Name:KOMRO, GLENDA (LPN/MASSAGE PRACT)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:KOMRO
Suffix:
Gender:F
Credentials:LPN/MASSAGE PRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W2499 COUNTY ROAD T
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:WI
Mailing Address - Zip Code:54736-5063
Mailing Address - Country:US
Mailing Address - Phone:715-495-5984
Mailing Address - Fax:
Practice Address - Street 1:W2499 COUNTY ROAD T
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:WI
Practice Address - Zip Code:54736-5063
Practice Address - Country:US
Practice Address - Phone:715-495-5984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist