Provider Demographics
NPI:1598771818
Name:1ST CHOICE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:1ST CHOICE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOVACEK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:586-247-1178
Mailing Address - Street 1:13725 19 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-2703
Mailing Address - Country:US
Mailing Address - Phone:586-247-1178
Mailing Address - Fax:586-247-3735
Practice Address - Street 1:13725 19 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-2703
Practice Address - Country:US
Practice Address - Phone:586-247-1178
Practice Address - Fax:586-247-3735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDA5114OtherMEDICARE RR
MI0P06790Medicare PIN
MIDA5114OtherMEDICARE RR