Healthcare Provider Details

I. General information

NPI: 1790214252
Provider Name (Legal Business Name): COMPLETE PT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 09/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S FORREST AVE
LIBERTY MO
64068-1908
US

IV. Provider business mailing address

8305 NE 105TH ST
KANSAS CITY MO
64157-9102
US

V. Phone/Fax

Practice location:
  • Phone: 515-341-2721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateMO

VIII. Authorized Official

Name: DR. GARY DWAYNE EICHENBERGER
Title or Position: PHYSICAL THERAPIST/ OWNER
Credential: DPT
Phone: 515-341-2721