Healthcare Provider Details

I. General information

NPI: 1467411496
Provider Name (Legal Business Name): SELECT PHYSICAL THERAPY LIMITED PARTNERSHIP FOR BETTER LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date: 12/07/2007
Reactivation Date: 02/06/2008

III. Provider practice location address

6325 NORTH AVONDALE AVENUE
CHICAGO IL
60631
US

IV. Provider business mailing address

6325 NORTH AVONDALE AVENUE
CHICAGO IL
60631
US

V. Phone/Fax

Practice location:
  • Phone: 773-792-8326
  • Fax:
Mailing address:
  • Phone: 773-792-8326
  • 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