Healthcare Provider Details

I. General information

NPI: 1629047733
Provider Name (Legal Business Name): SELECT PHYSICAL THERAPY HOLDINGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date: 11/07/2007
Reactivation Date: 12/13/2007

III. Provider practice location address

3290 N RIDGE RD STE 125
ELLICOTT CITY MD
21043
US

IV. Provider business mailing address

4714 GETTYSBURG RD LEGAL DPT
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 410-465-1080
  • Fax: 410-480-2580
Mailing address:
  • Phone: 717-972-1100
  • Fax: 717-975-9731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateMD
# 3
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: 717-972-1100