=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326062852
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST CHOICE PHYSICAL THERAPY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 10/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 S 17TH ST
-----------------------------------------------------
City | WORLAND
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-347-4292
-----------------------------------------------------
Fax | 307-347-3842
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 S 17TH ST
-----------------------------------------------------
City | WORLAND
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-347-4292
-----------------------------------------------------
Fax | 307-347-3842
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JENNIFER L VILLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 307-431-2414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT-297
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------