Healthcare Provider Details

I. General information

NPI: 1699744946
Provider Name (Legal Business Name): SELECT PHYSICAL THERAPY OF KENDALL, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11140 SW 88TH ST STE 200
MIAMI FL
33176-0901
US

IV. Provider business mailing address

4714 GETTYSBURG RD LEGAL
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-3223
  • Fax:
Mailing address:
  • Phone: 717-972-1100
  • Fax: 717-975-9981

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: 717-975-4503