Provider Demographics
NPI:1639256126
Name:COMPLETE PHYSICAL THERAPY AND WELLNESS PC
Entity Type:Organization
Organization Name:COMPLETE PHYSICAL THERAPY AND WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KEYES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-625-9466
Mailing Address - Street 1:6770 DIXIE HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2088
Mailing Address - Country:US
Mailing Address - Phone:248-625-9466
Mailing Address - Fax:
Practice Address - Street 1:6770 DIXIE HWY STE 104
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2088
Practice Address - Country:US
Practice Address - Phone:248-625-9466
Practice Address - Fax:248-625-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy