Provider Demographics
NPI:1184168197
Name:COMPLETE PHYSICAL THERAPY & WELLNESS, LLC
Entity type:Organization
Organization Name:COMPLETE PHYSICAL THERAPY & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BRASSARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:978-549-0837
Mailing Address - Street 1:60 AVON ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-4638
Mailing Address - Country:US
Mailing Address - Phone:978-549-0837
Mailing Address - Fax:
Practice Address - Street 1:960 SOUTH ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-7037
Practice Address - Country:US
Practice Address - Phone:978-549-0837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty