Matthew L Komnick, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

310 E Van Buren St
Clinton, IL 61727-2266

Phone

(217) 935-4380

Fax

(217) 935-0802

NPI assigned

Mar 6, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• CHW Physical Therapy PC

  • Physical Therapist
  • Clinton, IL
  • NPI 1063421204
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043340706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 N CENTER ST",
            "city": "CLINTON",
            "state": "IL",
            "postal_code": "617271408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 E VAN BUREN ST",
            "city": "CLINTON",
            "state": "IL",
            "postal_code": "617272266",
            "telephone_number": "217-935-4380",
            "fax_number": "217-935-0802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMNICK",
        "first_name": "MATTHEW",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Jarman, PTA
• Kara Lynn Johnson
• Kleeman Village
• Kari Kristine Klein, MS CCC SLP
• Subramaniam Kolandaivelu, M.D.
• Farrukh A Kureishy, MD
• Becky Largent, LCSW, APRN, PMHNP
• Sarah Larison
• John C Larkin, DMD
• Cassandra R Laskowski, MA, LCPC, CADC

• All providers in Clinton, IL
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.