Healthcare Provider Details

I. General information

NPI: 1356802698
Provider Name (Legal Business Name): COMPLETE WELLNESS PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8539 BENTON AVE
PHILADELPHIA PA
19152-1216
US

IV. Provider business mailing address

PO BOX 744
LANGHORNE PA
19047-0744
US

V. Phone/Fax

Practice location:
  • Phone: 267-251-7843
  • Fax:
Mailing address:
  • Phone: 267-251-7843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: YULIANA TAHMAZOV
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 267-251-7843