Provider Demographics
NPI:1821393844
Name:CHOICE PM&R LLC
Entity Type:Organization
Organization Name:CHOICE PM&R LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-206-0621
Mailing Address - Street 1:3540 CRAIN HWY
Mailing Address - Street 2:#383
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1303
Mailing Address - Country:US
Mailing Address - Phone:240-206-0621
Mailing Address - Fax:
Practice Address - Street 1:3540 CRAIN HWY
Practice Address - Street 2:#383
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1303
Practice Address - Country:US
Practice Address - Phone:240-206-0621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-23
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0069766208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty