Provider Demographics
NPI:1346423258
Name:COMPLETE THERAPY PC
Entity Type:Organization
Organization Name:COMPLETE THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:734-981-9410
Mailing Address - Street 1:2200 N CANTON CENTER RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5065
Mailing Address - Country:US
Mailing Address - Phone:734-981-9410
Mailing Address - Fax:734-981-9444
Practice Address - Street 1:2200 N CANTON CENTER RD
Practice Address - Street 2:SUITE 150
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5065
Practice Address - Country:US
Practice Address - Phone:734-981-9410
Practice Address - Fax:734-981-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003792261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherCOMMERCIAL
MI0H25877Medicare PIN