Provider Demographics
NPI:1922563402
Name:COMPLETE WELLNESS REHABILITATION, LLC
Entity Type:Organization
Organization Name:COMPLETE WELLNESS REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DINAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-842-5128
Mailing Address - Street 1:PO BOX 52283
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-7283
Mailing Address - Country:US
Mailing Address - Phone:215-842-5128
Mailing Address - Fax:267-297-8191
Practice Address - Street 1:5313 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-3203
Practice Address - Country:US
Practice Address - Phone:215-842-5128
Practice Address - Fax:267-297-8191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty