Healthcare Provider Details

I. General information

NPI: 1760451629
Provider Name (Legal Business Name): SELECT PHYSICAL THERAPY OF BIRMINGHAM LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date: 10/29/2007
Reactivation Date: 12/13/2007

III. Provider practice location address

1 INVERNESS CNT PKWY STE 200
BIRMINGHAM AL
35242
US

IV. Provider business mailing address

4714 GETTYSBURG RD
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 205-995-5192
  • Fax: 205-995-5139
Mailing address:
  • Phone: 717-975-4503
  • Fax: 717-975-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL E TARVIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 717-975-4503