Provider Demographics
NPI:1710593231
Name:COMPTON, DAVID TYLER (DPT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:TYLER
Last Name:COMPTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:276-935-6496
Mailing Address - Fax:
Practice Address - Street 1:190 CAPITAL PLZ STE 1
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-9465
Practice Address - Country:US
Practice Address - Phone:276-935-6496
Practice Address - Fax:276-935-5852
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2305213643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist