Provider Demographics
NPI:1568498236
Name:COMPASS PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:COMPASS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VON MAACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-763-0505
Mailing Address - Street 1:807 N TYNDALL PKWY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-9495
Mailing Address - Country:US
Mailing Address - Phone:850-763-0505
Mailing Address - Fax:
Practice Address - Street 1:807 N TYNDALL PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-9495
Practice Address - Country:US
Practice Address - Phone:850-763-0505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5287225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4011Medicare ID - Type Unspecified