Provider Demographics
NPI:1689332868
Name:CHOICE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CHOICE PHYSICAL THERAPY
Other - Org Name:CHOICE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-797-2572
Mailing Address - Street 1:6863 HOLLOPETER RD
Mailing Address - Street 2:
Mailing Address - City:LEO
Mailing Address - State:IN
Mailing Address - Zip Code:46765-9269
Mailing Address - Country:US
Mailing Address - Phone:260-797-2572
Mailing Address - Fax:
Practice Address - Street 1:701 NORTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-1633
Practice Address - Country:US
Practice Address - Phone:260-333-0031
Practice Address - Fax:260-333-0685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-04
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy