Provider Demographics
NPI:1558478248
Name:COMPTON, LARRY
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:COMPTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 NORTHCREST DR
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4230
Mailing Address - Country:US
Mailing Address - Phone:405-436-2596
Mailing Address - Fax:
Practice Address - Street 1:2020 ARLINGTON ST
Practice Address - Street 2:STE 1
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2822
Practice Address - Country:US
Practice Address - Phone:580-332-5124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK547OtherLICENSE #