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General NPI Number Information
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NPI Number | 1396476032
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Entity Type | Organization
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Legal Business Name | COMPCARE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 4224 W FRONTAGE RD N
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City | ROCHESTER
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State | MN
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Zip | 55901-0130
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Country | US
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Telephone | 651-508-0936
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Fax |
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Provider Business Mailing Address
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Address Line | 4224 W FRONTAGE RD N
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City | ROCHESTER
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State | MN
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Zip | 55901-0130
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Country | US
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Telephone | 651-508-0936
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | SHANNON KNOX
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Credential |
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Telephone | 507-405-2259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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