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General NPI Number Information
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NPI Number | 1992591416
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Entity Type | Organization
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Legal Business Name | CHOICE PHYSICAL THERAPY SOUTHWEST LLC
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 212 E MAIN ST
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City | NORTH MANCHESTER
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State | IN
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Zip | 46962-1823
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Country | US
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Telephone | 260-797-2572
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Fax |
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Provider Business Mailing Address
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Address Line | 6863 HOLLOPETER RD
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City | LEO
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State | IN
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Zip | 46765-9269
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Country | US
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Telephone | 260-797-2572
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW WAGNER
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Credential |
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Telephone | 260-797-2572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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