Provider Demographics
NPI:1083860688
Name:COMPLETE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:COMPLETE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGLETARY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:601-940-5730
Mailing Address - Street 1:148 SONNETT CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7653
Mailing Address - Country:US
Mailing Address - Phone:601-853-9291
Mailing Address - Fax:601-354-5322
Practice Address - Street 1:809 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2604
Practice Address - Country:US
Practice Address - Phone:601-354-5722
Practice Address - Fax:601-354-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3460261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy