1306141882 NPI number — FIRST CHOICE THERAPY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306141882 NPI number — FIRST CHOICE THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST CHOICE THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306141882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39407 COUNTY ROAD 45
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAPORTE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6068 E OTTERTAIL RD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALKER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-760-0226
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WATSON
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
218-760-0226

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  5740 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)