Healthcare Provider Details

I. General information

NPI: 1386613073
Provider Name (Legal Business Name): SELECT PHYSICAL THERAPY OF PORTOLA VALLEY LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 FOREST AVE
PALO ALTO CA
94301-2608
US

IV. Provider business mailing address

454 FOREST AVE
PALO ALTO CA
94301-2608
US

V. Phone/Fax

Practice location:
  • Phone: 650-331-3700
  • Fax: 650-331-3730
Mailing address:
  • Phone: 650-331-3700
  • Fax: 650-331-3730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL TARVIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 717-972-1100