Provider Demographics
NPI:1669672630
Name:FIRST CHOICE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:FIRST CHOICE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:BS, EXSS
Authorized Official - Phone:541-229-2212
Mailing Address - Street 1:2395 NW STEWART PKWY
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-5653
Mailing Address - Country:US
Mailing Address - Phone:541-229-2212
Mailing Address - Fax:541-229-2213
Practice Address - Street 1:2395 NW STEWART PKWY
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-5653
Practice Address - Country:US
Practice Address - Phone:541-229-2212
Practice Address - Fax:541-229-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4760261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR138354Medicare PIN