Healthcare Provider Details

I. General information

NPI: 1841250305
Provider Name (Legal Business Name): SELECT PHYSICAL THERAPY HOLDINGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date: 11/20/2007
Reactivation Date: 01/04/2008

III. Provider practice location address

7714 BROOKLYN BLVD STE 201
BROOKLYN PARK MN
55443-2965
US

IV. Provider business mailing address

4716 OLD GETTYSBURG RD
MECHANICSBURG PA
17055
US

V. Phone/Fax

Practice location:
  • Phone: 763-566-3919
  • Fax:
Mailing address:
  • Phone: 717-975-4503
  • Fax: 717-975-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL TARVIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 717-975-4503