Provider Demographics
NPI:1104125194
Name:COMPASS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:COMPASS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PIETROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-728-0974
Mailing Address - Street 1:915 NE 7TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4515
Mailing Address - Country:US
Mailing Address - Phone:541-728-0974
Mailing Address - Fax:541-728-0159
Practice Address - Street 1:915 NE 7TH ST STE 1
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4515
Practice Address - Country:US
Practice Address - Phone:541-728-0974
Practice Address - Fax:541-728-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty