Healthcare Provider Details

I. General information

NPI: 1215605860
Provider Name (Legal Business Name): HD ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 SW EMKAY DR
BEND OR
97702-1010
US

IV. Provider business mailing address

1012 SW EMKAY DR
BEND OR
97702-1010
US

V. Phone/Fax

Practice location:
  • Phone: 972-658-3582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHANNON COMPTON
Title or Position: OWNER
Credential: PT, DPT
Phone: 972-658-3582