Provider Demographics
NPI:1831325620
Name:CHOICE THERAPY, P.A.
Entity type:Organization
Organization Name:CHOICE THERAPY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BRODINA
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:218-444-8280
Mailing Address - Street 1:3835 SUPREME CT NW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-4446
Mailing Address - Country:US
Mailing Address - Phone:218-444-8280
Mailing Address - Fax:
Practice Address - Street 1:3835 SUPREME CT NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4446
Practice Address - Country:US
Practice Address - Phone:218-444-8280
Practice Address - Fax:218-444-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-07
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6604225100000X
MN3079225100000X
MN101597225X00000X
225X00000X, 235Z00000X, 225100000X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty