Provider Demographics
NPI:1003139346
Name:CHOICE THERAPY SERVICES, LTD
Entity Type:Organization
Organization Name:CHOICE THERAPY SERVICES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-369-8122
Mailing Address - Street 1:21437 PRAIRIE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1953
Mailing Address - Country:US
Mailing Address - Phone:708-369-8122
Mailing Address - Fax:708-478-8122
Practice Address - Street 1:21437 PRAIRIE RIDGE DR
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-1953
Practice Address - Country:US
Practice Address - Phone:708-369-8122
Practice Address - Fax:708-478-8122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070006803208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty