Healthcare Provider Details

I. General information

NPI: 1982719746
Provider Name (Legal Business Name): SELECT REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TWINRIDGE LN
NORTH CHESTERFIELD VA
23235-5248
US

IV. Provider business mailing address

2600 COMPASS RD
GLENVIEW IL
60026-8001
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-5629
  • Fax: 434-792-1981
Mailing address:
  • Phone: 847-441-5593
  • Fax: 847-386-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ANNA GARDINA
Title or Position: PRESIDENT
Credential:
Phone: 847-441-5593