Provider Demographics
NPI:1295307924
Name:PRIME CHOICE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PRIME CHOICE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AYANA
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:336-529-1682
Mailing Address - Street 1:2916 WINDY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-4676
Mailing Address - Country:US
Mailing Address - Phone:336-529-1682
Mailing Address - Fax:
Practice Address - Street 1:7820 N POINT BLVD STE 107
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3299
Practice Address - Country:US
Practice Address - Phone:336-529-1682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy