Provider Demographics
NPI:1083924989
Name:COMPASS THERAPEUTICS INC
Entity Type:Organization
Organization Name:COMPASS THERAPEUTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WILT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:814-330-4603
Mailing Address - Street 1:3332 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1027
Mailing Address - Country:US
Mailing Address - Phone:724-654-4457
Mailing Address - Fax:724-654-2909
Practice Address - Street 1:3332 PLANK RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1027
Practice Address - Country:US
Practice Address - Phone:724-654-4457
Practice Address - Fax:724-654-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016349225100000X
PAOC009189225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty