Healthcare Provider Details

I. General information

NPI: 1164536108
Provider Name (Legal Business Name): SELECT CARE PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7762 N FEDERAL ROAD
HOWARDCITY MI
49329
US

IV. Provider business mailing address

7762 N FEDERAL ROAD P.O.BOX256
HOWARDCITY MI
49329
US

V. Phone/Fax

Practice location:
  • Phone: 231-937-8485
  • Fax: 231-937-9836
Mailing address:
  • Phone: 231-937-8485
  • Fax: 231-937-9836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. PROMODH JOSEPH
Title or Position: OWNER
Credential: PT
Phone: 231-937-8485