Provider Demographics
NPI:1003648064
Name:CHOICE PHYSICAL THERAPY AND WELLNESS LLC
Entity type:Organization
Organization Name:CHOICE PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:920-841-3018
Mailing Address - Street 1:1835 E EDGEWOOD DR STE 10583
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-9407
Mailing Address - Country:US
Mailing Address - Phone:920-841-3018
Mailing Address - Fax:
Practice Address - Street 1:N1287 LAUDON LN
Practice Address - Street 2:
Practice Address - City:HORTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54944-9382
Practice Address - Country:US
Practice Address - Phone:920-841-3018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty