Healthcare Provider Details

I. General information

NPI: 1932654647
Provider Name (Legal Business Name): SELECT MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 S CHESTER RD
SWARTHMORE PA
19081-2315
US

IV. Provider business mailing address

623 S CHESTER RD
SWARTHMORE PA
19081-2315
US

V. Phone/Fax

Practice location:
  • Phone: 610-543-1201
  • Fax: 610-328-5205
Mailing address:
  • Phone: 610-543-1201
  • Fax: 610-328-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT025306
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JASON HEYDUK
Title or Position: REGIONAL MANAGER
Credential: PT,DPT
Phone: 610-543-1201