Provider Demographics
NPI:1881452084
Name:COMPEAU, MICAYLA
Entity type:Individual
Prefix:
First Name:MICAYLA
Middle Name:
Last Name:COMPEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 W ROMEO RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48363-1442
Mailing Address - Country:US
Mailing Address - Phone:248-765-6384
Mailing Address - Fax:
Practice Address - Street 1:280 PULLMAN SQ STE 265
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5654
Practice Address - Country:US
Practice Address - Phone:724-282-4764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT031461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist