Provider Demographics
NPI:1447037718
Name:COMPLETE PHYSICAL THERAPY & AQUATICS LLC
Entity type:Organization
Organization Name:COMPLETE PHYSICAL THERAPY & AQUATICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWNELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:330-246-0572
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44424-0196
Mailing Address - Country:US
Mailing Address - Phone:330-246-0572
Mailing Address - Fax:
Practice Address - Street 1:761 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-1125
Practice Address - Country:US
Practice Address - Phone:330-246-0572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty