Provider Demographics
NPI:1578227856
Name:CHOICE PHYSICAL THERAPY CLINIC LLC
Entity Type:Organization
Organization Name:CHOICE PHYSICAL THERAPY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDOULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:502-919-1508
Mailing Address - Street 1:10612 BROOKCHASE CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-1967
Mailing Address - Country:US
Mailing Address - Phone:502-919-1508
Mailing Address - Fax:
Practice Address - Street 1:4109 BARDSTOWN RD STE 105
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3297
Practice Address - Country:US
Practice Address - Phone:502-919-1508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy