MEDICARE: PHYSICAL THERAPY COMPLETE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2Z1876	OTHER	AZ	HEALTHNET PROVIDER ID
2	8145185	OTHER	AZ	AETNA PROVIDER ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P0460470	OTHER	AZ	BCBS OF ARIZONA

General Provider Information

NPI Number	:	1780651158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY COMPLETE PLLC

Provider Business Mailing Address
First Line	:	375 E VIRGINIA AVE
Second Line	:	SUITE B
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1220
Country	:	US
Telephone Number	:	602-264-5323
Fax Number	:	602-264-5302

Provider Business Practice Location Address
First Line	:	375 E VIRGINIA AVE
Second Line	:	SUITE B
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1220
Country	:	US
Telephone Number	:	602-264-5323
Fax Number	:	602-264-5302

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	MR. PAUL JOHN GLEASON
Credential	:	P.T.
Telephone Number	:	602-264-5323

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	11/27/2007

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Directions to “PHYSICAL THERAPY COMPLETE PLLC ” Practice Location

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