Healthcare Provider Details

I. General information

NPI: 1215055439
Provider Name (Legal Business Name): COMPLETE REHABILITATION SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W BLAND ST
ROSWELL NM
88203-5708
US

IV. Provider business mailing address

PO BOX 3893
ROSWELL NM
88202-3893
US

V. Phone/Fax

Practice location:
  • Phone: 575-625-2525
  • Fax:
Mailing address:
  • Phone: 575-625-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LYNN HURST
Title or Position: OWNER
Credential:
Phone: 575-625-2525