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General NPI Number Information
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NPI Number | 1346117512
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Entity Type | Organization
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Legal Business Name | COMPLEX REHAB TECHNOLOGIES LLC
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 8408 ANNALISE DR UNIT 155
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City | AUSTIN
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State | TX
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Zip | 78744-5452
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Country | US
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Telephone | 512-792-9501
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Fax | 512-792-9534
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Provider Business Mailing Address
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Address Line | 9495 WINNETKA AVE N STE 200
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City | BROOKLYN PARK
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State | MN
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Zip | 55445-1706
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Country | US
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Telephone | 763-255-3800
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Fax |
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Authorized Official
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Title or Position | SENIOR DIRECTOR OF PAYOR RELATIONS
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Name | KILEY ANN RUSSELL
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Credential |
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Telephone | 629-252-8211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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