Provider Demographics
NPI:1114291903
Name:COMPAGNA, RENEE (LMT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:COMPAGNA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5619
Mailing Address - Country:US
Mailing Address - Phone:603-494-3808
Mailing Address - Fax:
Practice Address - Street 1:202 W 22ND ST
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4618
Practice Address - Country:US
Practice Address - Phone:970-259-0968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12480172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist