Provider Demographics
NPI:1467579441
Name:COMPASS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:COMPASS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-763-0505
Mailing Address - Street 1:515 S HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:WEWAHITCHKA
Mailing Address - State:FL
Mailing Address - Zip Code:32465-4507
Mailing Address - Country:US
Mailing Address - Phone:850-639-6611
Mailing Address - Fax:850-639-6616
Practice Address - Street 1:515 S HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:WEWAHITCHKA
Practice Address - State:FL
Practice Address - Zip Code:32465-4507
Practice Address - Country:US
Practice Address - Phone:850-639-6611
Practice Address - Fax:850-639-6616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5825261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY905DOtherBCBS OF FLORIDA
FLK4011Medicare ID - Type Unspecified