Healthcare Provider Details

I. General information

NPI: 1114948130
Provider Name (Legal Business Name): SELECT PHYSICAL THERAPY HOLDINGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date: 11/20/2007
Reactivation Date: 01/04/2008

III. Provider practice location address

9011 NORTH MERIDIAN STREET
INDIANAPOLIS IN
46260
US

IV. Provider business mailing address

4714 GETTYSBURG RD LEGAL DPT
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 317-571-0017
  • Fax: 317-571-1555
Mailing address:
  • Phone: 717-972-1100
  • 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 StateIN

VIII. Authorized Official

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