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General NPI Number Information
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NPI Number | 1891039632
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Entity Type | Organization
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Legal Business Name | COMPLETE HOMETOWN PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 203 N MAIN ST
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City | HALLETTSVILLE
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State | TX
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Zip | 77964-2729
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Country | US
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Telephone | 512-393-4100
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Fax | 361-238-5000
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Provider Business Mailing Address
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Address Line | PO BOX 248
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City | HALLETTSVILLE
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State | TX
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Zip | 77964-0248
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Country | US
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Telephone | 512-743-1580
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Fax | 361-238-5000
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Authorized Official
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Title or Position | OWNER/PT
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Name | MRS. KELLY DEANN CHANCE
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Credential | PT
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Telephone | 512-393-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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