Provider Demographics
NPI:1932450764
Name:COMPTY, MICHELLE (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:COMPTY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:5502 WASHINGTON AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4093
Practice Address - Country:US
Practice Address - Phone:262-637-2470
Practice Address - Fax:262-637-2532
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13339225100000X
FL27778225100000X
SC6803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400313338Medicare PIN