MEDICARE: DR. MARY LEANNE COMPTON PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT39100	CA

General Provider Information

NPI Number	:	1942559109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY LEANNE COMPTON PT, DPT

Provider Business Mailing Address
First Line	:	3896 MARLESTA DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-3505
Country	:	US
Telephone Number	:	818-355-2478
Fax Number	:

Provider Business Practice Location Address
First Line	:	2445 TRUXTUN RD STE 205
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-6154
Country	:	US
Telephone Number	:	619-633-2119
Fax Number	:	619-633-2120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2012
Last Update Date	:	08/03/2022

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