Provider Demographics
NPI:1326350489
Name:PHYSIO CHOICE INC
Entity Type:Organization
Organization Name:PHYSIO CHOICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOLALE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAIRU-CASWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-718-7641
Mailing Address - Street 1:104 IBISCA TER
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4321
Mailing Address - Country:US
Mailing Address - Phone:561-718-7641
Mailing Address - Fax:561-214-4584
Practice Address - Street 1:104 IBISCA TER
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4321
Practice Address - Country:US
Practice Address - Phone:561-718-7641
Practice Address - Fax:561-214-4584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22907253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care