Provider Demographics
NPI:1982807582
Name:COMPLETE PHYSICAL THERAPY & SPORTS, PLLC
Entity Type:Organization
Organization Name:COMPLETE PHYSICAL THERAPY & SPORTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:512-638-3442
Mailing Address - Street 1:2700 W ANDERSON LN
Mailing Address - Street 2:STE 904
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1159
Mailing Address - Country:US
Mailing Address - Phone:512-638-3442
Mailing Address - Fax:512-420-9090
Practice Address - Street 1:2700 W ANDERSON LN
Practice Address - Street 2:STE 904
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1159
Practice Address - Country:US
Practice Address - Phone:512-638-3442
Practice Address - Fax:512-420-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11263652251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX659908OtherBLUE CROSS BLUE SHIELD