Active NPI
Jeffrey G Komay, PTA
- Physical Therapy Assistant
- Holmen, WI
National Provider Identifier
1437321551
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 1009-19
- Practice address
- 106 S Holmen Dr
Suite 2
Holmen, WI 54636-9467 - Phone
- (608) 526-9888
- NPI assigned
- Mar 28, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 1009-19 | WI | Primary |
Addresses
Primary practice location
106 S Holmen Dr
Suite 2
Holmen, WI 54636-9467
Mailing address
106 S Holmen Dr
Suite 2
Holmen, WI 54636-9467
Phone (608) 526-9888
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40387800 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1009-19 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206662400000",
"number": "1437321551",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106 S HOLMEN DR",
"address_2": "SUITE 2",
"city": "HOLMEN",
"state": "WI",
"postal_code": "546369467",
"telephone_number": "608-526-9888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 S HOLMEN DR",
"address_2": "SUITE 2",
"city": "HOLMEN",
"state": "WI",
"postal_code": "546369467",
"telephone_number": "608-526-9888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOMAY",
"first_name": "JEFFREY",
"middle_name": "G",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-03-28",
"last_updated": "2008-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "1009-19",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40387800",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Holmen, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.