MEDICARE: COMPLETE PHYSICAL THERAPY & SPORTS, 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	2251X0800X	Orthopedic Physical Therapist	1126365	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	659908	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1982807582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE PHYSICAL THERAPY & SPORTS, PLLC

Provider Business Mailing Address
First Line	:	2700 W ANDERSON LN
Second Line	:	STE 904
City	:	AUSTIN
State	:	TX
Zip	:	78757-1159
Country	:	US
Telephone Number	:	512-638-3442
Fax Number	:	512-420-9090

Provider Business Practice Location Address
First Line	:	2700 W ANDERSON LN
Second Line	:	STE 904
City	:	AUSTIN
State	:	TX
Zip	:	78757-1159
Country	:	US
Telephone Number	:	512-638-3442
Fax Number	:	512-420-9090

Authorized Official
Title or Position	:	PHYSICAL THERAPIST OWNER
Name	:	MRS. JENNIFER C GARNER
Credential	:	MPT
Telephone Number	:	512-638-3442

Provider Enumeration Date	:	06/09/2007
Last Update Date	:	08/22/2020

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