Provider Demographics
NPI:1639643760
Name:COMPASS PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:COMPASS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUCHHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:540-409-1764
Mailing Address - Street 1:2266 HENSHAW RD
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-3662
Mailing Address - Country:US
Mailing Address - Phone:540-409-1764
Mailing Address - Fax:717-473-4053
Practice Address - Street 1:2266 HENSHAW RD
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:WV
Practice Address - Zip Code:25428-3662
Practice Address - Country:US
Practice Address - Phone:540-409-1764
Practice Address - Fax:717-473-4053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPT003748OtherWEST VIRGINIA STATE PHYSICAL THERAPY LICENSE