Provider Demographics
NPI:1265951289
Name:COMPLETE BODY WELLNESS STUDIO, LLC
Entity type:Organization
Organization Name:COMPLETE BODY WELLNESS STUDIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:770-712-5955
Mailing Address - Street 1:405 MILLERS CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-2515
Mailing Address - Country:US
Mailing Address - Phone:770-712-5955
Mailing Address - Fax:770-889-0244
Practice Address - Street 1:11805 NORTHFALL LN STE 804
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7970
Practice Address - Country:US
Practice Address - Phone:770-712-5955
Practice Address - Fax:770-889-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)