Healthcare Provider Details

I. General information

NPI: 1871601088
Provider Name (Legal Business Name): FIRST CHOICE PHYSICAL THERAPY OF HANNIBAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N 3RD ST
HANNIBAL MO
63401-3501
US

IV. Provider business mailing address

5 STATE AND 8TH PLZ
QUINCY IL
62301-4960
US

V. Phone/Fax

Practice location:
  • Phone: 573-248-1350
  • Fax: 573-248-1649
Mailing address:
  • Phone: 217-224-1750
  • Fax: 217-224-0403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2005037474
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number02152
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2004022431
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number112276
License Number StateMO

VIII. Authorized Official

Name: BRYAN ALBRIGHT
Title or Position: MANAGING MEMBER
Credential:
Phone: 573-248-1350