Provider Demographics
NPI:1528253077
Name:COMPEAN, CHRSTIAN EDGAR (PT)
Entity type:Individual
Prefix:
First Name:CHRSTIAN
Middle Name:EDGAR
Last Name:COMPEAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23127 IH 10 W
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-2505
Mailing Address - Country:US
Mailing Address - Phone:210-698-6333
Mailing Address - Fax:210-698-6332
Practice Address - Street 1:23127 IH 10 W
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-2505
Practice Address - Country:US
Practice Address - Phone:210-698-6333
Practice Address - Fax:210-698-6332
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2012-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160246225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2143786Medicaid
TXTXB162347OtherMEDICARE PTAN