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General NPI Number Information
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NPI Number | 1104885136
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Entity Type | Organization
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Legal Business Name | SELECT PHYSICAL THERAPY OF ILLINOIS LIMITED PARTNERSHIP
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 820 E TERRA COTTA AVE STE 102
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014
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Country | US
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Telephone | 815-455-3262
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Fax | 815-455-2729
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Provider Business Mailing Address
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Address Line | 4714 GETTYSBURG RD
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City | MECHANICSBURG
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State | PA
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Zip | 17055-4325
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Country | US
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Telephone | 717-972-1100
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Fax | 717-975-9781
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MICHAEL E TARVIN
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Credential |
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Telephone | 717-972-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | IL
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