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General NPI Number Information
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NPI Number | 1922563402
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Entity Type | Organization
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Legal Business Name | COMPLETE WELLNESS REHABILITATION, LLC
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Dates
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Enumeration Date | 02/08/2019
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 5313 N 5TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19120-3203
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Country | US
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Telephone | 215-842-5128
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Fax | 267-297-8191
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Provider Business Mailing Address
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Address Line | PO BOX 52283
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City | PHILADELPHIA
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State | PA
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Zip | 19115-7283
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Country | US
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Telephone | 215-842-5128
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Fax | 267-297-8191
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. DINAH WILLIAMS
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Credential |
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Telephone | 215-842-5128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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