Healthcare Provider Details

I. General information

NPI: 1164578282
Provider Name (Legal Business Name): SELECT PHYSICAL THERAPY OF KENDALL LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date: 11/20/2007
Reactivation Date: 01/04/2008

III. Provider practice location address

11140 SW 88TH ST STE 200
MIAMI FL
33176
US

IV. Provider business mailing address

4716 OLD GETTYSBURG RD
MECHANICSBURG PA
17055-0901
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-3223
  • Fax: 305-271-2905
Mailing address:
  • Phone: 717-975-4503
  • Fax: 717-975-9781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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