Basic Information
Provider Information
NPI: 1124321625
EntityType: 2
ReplacementNPI:  
OrganizationName: SELECT PHYSICAL THERAPY HOLDINGS INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4714 GETTYSBURG RD
Address2: LEGAL DEPARTMENT
City: MECHANICSBURG
State: PA
PostalCode: 170554325
CountryCode: US
TelephoneNumber: 7179721100
FaxNumber:  
Practice Location
Address1: 913 HIGHWAY BUSINESS 60 WEST
Address2:  
City: DEXTER
State: MO
PostalCode: 638412876
CountryCode: US
TelephoneNumber: 5736246405
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/06/2010
LastUpdateDate: 01/21/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: TARVIN
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VICE PRESIDENT
AuthorizedOfficialTelephone: 7179754503
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QP2000X  Y Ambulatory Health Care FacilitiesClinic/CenterPhysical Therapy

No ID Information.


Home