Provider Demographics
NPI:1922158906
Name:COMPASSO, AMY LENORA (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LENORA
Last Name:COMPASSO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 MADRID ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3544
Mailing Address - Country:US
Mailing Address - Phone:415-469-7763
Mailing Address - Fax:
Practice Address - Street 1:500 SUTTER ST
Practice Address - Street 2:SUITE 512
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1107
Practice Address - Country:US
Practice Address - Phone:415-282-4083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0PT211600Medicare PIN