Provider Demographics
NPI:1184958548
Name:COMPLETE BODY PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:COMPLETE BODY PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:401-864-3006
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-0456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1452 BRONCOS HWY
Practice Address - Street 2:SUITE 3
Practice Address - City:BURRILLVILLE
Practice Address - State:RI
Practice Address - Zip Code:02830-1660
Practice Address - Country:US
Practice Address - Phone:401-864-3006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01789261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy