Provider Demographics
NPI:1003191370
Name:OTP CHOICE REHABILITATION LP
Entity type:Organization
Organization Name:OTP CHOICE REHABILITATION LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES OF GEN PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-572-9000
Mailing Address - Street 1:721 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-1119
Mailing Address - Country:US
Mailing Address - Phone:260-724-2400
Mailing Address - Fax:260-724-2402
Practice Address - Street 1:721 N 13TH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-1119
Practice Address - Country:US
Practice Address - Phone:260-724-2400
Practice Address - Fax:260-724-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy