Provider Demographics
NPI:1548388697
Name:COMPLETE PHYSICAL THERAPY & DIAGNOSTIC CENTER, LLC
Entity Type:Organization
Organization Name:COMPLETE PHYSICAL THERAPY & DIAGNOSTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LECLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-822-3031
Mailing Address - Street 1:555 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-8716
Mailing Address - Country:US
Mailing Address - Phone:770-822-3031
Mailing Address - Fax:770-822-3032
Practice Address - Street 1:555 OLD NORCROSS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-8716
Practice Address - Country:US
Practice Address - Phone:770-822-3031
Practice Address - Fax:770-822-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026300208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty