Provider Demographics
NPI:1740406388
Name:COMPASS MANUAL THERAPY, LLC
Entity Type:Organization
Organization Name:COMPASS MANUAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:M
Authorized Official - Last Name:RENNINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:360-675-9030
Mailing Address - Street 1:520 E WHIDBEY AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5922
Mailing Address - Country:US
Mailing Address - Phone:360-675-9030
Mailing Address - Fax:360-675-2204
Practice Address - Street 1:520 E WHIDBEY AVE
Practice Address - Street 2:STE 102
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5922
Practice Address - Country:US
Practice Address - Phone:360-675-9030
Practice Address - Fax:360-675-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8859435Medicare ID - Type Unspecified