Healthcare Provider Details

I. General information

NPI: 1689501678
Provider Name (Legal Business Name): COMPASS PEDIATRIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 PARKER DR STE 3AND4
MONROE GA
30656-1100
US

IV. Provider business mailing address

80 PARKER DR STE 3AND4
MONROE GA
30656-1100
US

V. Phone/Fax

Practice location:
  • Phone: 706-240-3593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOHN GEREGA
Title or Position: CEO
Credential: DPT
Phone: 724-462-6644