Provider Demographics
NPI:1508036526
Name:COMPLETE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:COMPLETE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-699-1580
Mailing Address - Street 1:6309 BALTIMORE AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1059
Mailing Address - Country:US
Mailing Address - Phone:301-699-1580
Mailing Address - Fax:301-699-1583
Practice Address - Street 1:6309 BALTIMORE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1059
Practice Address - Country:US
Practice Address - Phone:301-699-1580
Practice Address - Fax:301-699-1583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14782261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy