=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982807582
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPLETE PHYSICAL THERAPY & SPORTS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 W ANDERSON LN STE 904
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78757-1159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-638-3442
-----------------------------------------------------
Fax | 512-420-9090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2700 W ANDERSON LN STE 904
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78757-1159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-638-3442
-----------------------------------------------------
Fax | 512-420-9090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST OWNER
-----------------------------------------------------
Name | MRS. JENNIFER C GARNER
-----------------------------------------------------
Credential | MPT
-----------------------------------------------------
Telephone | 512-638-3442
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 1126365
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------