Provider Demographics
NPI:1356058945
Name:COMPASS, BETTINA (MMT)
Entity type:Individual
Prefix:MS
First Name:BETTINA
Middle Name:
Last Name:COMPASS
Suffix:
Gender:F
Credentials:MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 EDWARD L GRANT HWY APT 3C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-3154
Mailing Address - Country:US
Mailing Address - Phone:718-310-0673
Mailing Address - Fax:
Practice Address - Street 1:1441 EDWARD L GRANT HWY APT 3C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-3154
Practice Address - Country:US
Practice Address - Phone:718-310-0673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029642225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist