Provider Demographics
NPI:1316503162
Name:COMPASS PHYSICAL THERAPY
Entity type:Organization
Organization Name:COMPASS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GEREGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-462-6644
Mailing Address - Street 1:832 ASHLAND FALLS DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-6305
Mailing Address - Country:US
Mailing Address - Phone:724-462-6644
Mailing Address - Fax:
Practice Address - Street 1:2735 LOGANVILLE HWY STE B
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-8615
Practice Address - Country:US
Practice Address - Phone:724-462-6644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy