Provider Demographics
NPI:1225347628
Name:COMMUNITY CHOICE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:COMMUNITY CHOICE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-574-3181
Mailing Address - Street 1:3710 SAN JACINTO CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6124
Mailing Address - Country:US
Mailing Address - Phone:407-574-3181
Mailing Address - Fax:
Practice Address - Street 1:2500 W LAKE MARY BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3501
Practice Address - Country:US
Practice Address - Phone:407-574-3181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-02
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty