Healthcare Provider Details

I. General information

NPI: 1487623096
Provider Name (Legal Business Name): SELECT PHYSICAL THERAPY HOLDINGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23441 MADISON ST STE 330 BLDG 8
TORRANCE CA
90505-4725
US

IV. Provider business mailing address

23441 MADISON ST STE 330 BLDG 8
TORRANCE CA
90505-4725
US

V. Phone/Fax

Practice location:
  • Phone: 310-665-7141
  • Fax:
Mailing address:
  • Phone: 310-665-7141
  • Fax:

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