Healthcare Provider Details

I. General information

NPI: 1730359456
Provider Name (Legal Business Name): SELECT PHYSICAL THERAPY HOLDINGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 S WELLS ST
EDNA TX
77957-4045
US

IV. Provider business mailing address

1013 S WELLS ST
EDNA TX
77957-4045
US

V. Phone/Fax

Practice location:
  • Phone: 361-782-5627
  • Fax:
Mailing address:
  • Phone: 361-782-5627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: 717-972-1100