Provider Demographics
NPI:1770703266
Name:CHOICE PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:CHOICE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CERDA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:951-587-8105
Mailing Address - Street 1:41278 MARGARITA ROAD
Mailing Address - Street 2:SUITE 102 CHOICE PHYSICAL THERAPY INC
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591
Mailing Address - Country:US
Mailing Address - Phone:951-587-8105
Mailing Address - Fax:951-587-8405
Practice Address - Street 1:41278 MARGARITA ROAD
Practice Address - Street 2:SUITE 102 CHOICE PHYSICAL THERAPY INC
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591
Practice Address - Country:US
Practice Address - Phone:951-587-8105
Practice Address - Fax:951-587-8405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02382ZOtherBLUE SHIELD OF CA GRP PIN
ZZZ29191ZMedicare ID - Type Unspecified