Provider Demographics
NPI:1891812889
Name:COMPASS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:COMPASS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-763-0505
Mailing Address - Street 1:180 POINCIANA BLVD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32550-7049
Mailing Address - Country:US
Mailing Address - Phone:850-269-1717
Mailing Address - Fax:850-276-2022
Practice Address - Street 1:180 POINCIANA BLVD
Practice Address - Street 2:SUITE #4
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32550-7049
Practice Address - Country:US
Practice Address - Phone:850-269-1717
Practice Address - Fax:850-276-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7395261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY905DOtherBCBS OF FLORIDA
FLY905DOtherBCBS OF FLORIDA