Provider Demographics
NPI:1780651158
Name:PHYSICAL THERAPY COMPLETE PLLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY COMPLETE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-264-5323
Mailing Address - Street 1:375 E VIRGINIA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1220
Mailing Address - Country:US
Mailing Address - Phone:602-264-5323
Mailing Address - Fax:602-264-5302
Practice Address - Street 1:375 E VIRGINIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1220
Practice Address - Country:US
Practice Address - Phone:602-264-5323
Practice Address - Fax:602-264-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2Z1876OtherHEALTHNET PROVIDER ID
AZ8145185OtherAETNA PROVIDER ID
AZ854184Medicaid
AZP0460470OtherBCBS OF ARIZONA
AZ854184Medicaid