Healthcare Provider Details

I. General information

NPI: 1083860688
Provider Name (Legal Business Name): COMPLETE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 N STATE ST
JACKSON MS
39202-2604
US

IV. Provider business mailing address

148 SONNETT CIR
MADISON MS
39110-7653
US

V. Phone/Fax

Practice location:
  • Phone: 601-354-5722
  • Fax: 601-354-5322
Mailing address:
  • Phone: 601-853-9291
  • Fax: 601-354-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT3460
License Number StateMS

VIII. Authorized Official

Name: NIKI SINGLETARY
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: PT
Phone: 601-940-5730