Healthcare Provider Details

I. General information

NPI: 1437438546
Provider Name (Legal Business Name): COMPLETE REHAB & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2011
Last Update Date: 08/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9825 GILES RD SUITE F
LA VISTA NE
68128-2927
US

IV. Provider business mailing address

9825 GILES RD SUITE F
LA VISTA NE
68128-2927
US

V. Phone/Fax

Practice location:
  • Phone: 402-339-2283
  • Fax: 402-339-2289
Mailing address:
  • Phone: 402-339-2283
  • Fax: 402-339-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PETER K. YOUNG
Title or Position: OWNER/CEO
Credential: D. C.
Phone: 402-339-2283