Basic Information
| Provider Information | |||||||||
| NPI: | 1457867061 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FUNCTIONAL COMPASS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1012 | ||||||||
| Address2: | |||||||||
| City: | CARBONDALE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816231012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202182731 | ||||||||
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| Practice Location | |||||||||
| Address1: | 868 MELISSA LN | ||||||||
| Address2: | |||||||||
| City: | CARBONDALE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816232819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202182731 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2017 | ||||||||
| LastUpdateDate: | 12/19/2017 | ||||||||
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| AuthorizedOfficialLastName: | SEAHORN | ||||||||
| AuthorizedOfficialFirstName: | CHAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 7202182731 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MSPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 6868 | CO | Y | Agencies | Home Health |
No ID Information.