Provider Demographics
NPI:1619031010
Name:FIRST CHOICE PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:FIRST CHOICE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-439-3750
Mailing Address - Street 1:2609 CHARLEVOIX RD
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8524
Mailing Address - Country:US
Mailing Address - Phone:231-439-3750
Mailing Address - Fax:231-439-5918
Practice Address - Street 1:2609 CHARLEVOIX RD
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8524
Practice Address - Country:US
Practice Address - Phone:231-439-3750
Practice Address - Fax:231-439-5918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N14540Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER