=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538120654
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SELECT PHYSICAL THERAPY HOLDINGS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2006
-----------------------------------------------------
Last Update Date | 12/13/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 449 W MT PLEASANT AVE
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-994-4300
-----------------------------------------------------
Fax | 973-944-7923
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4716 OLD GETTYSBURG RD
-----------------------------------------------------
City | MECHANICSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-975-4503
-----------------------------------------------------
Fax | 717-975-9981
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MICHAEL E TARVIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-975-4503
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------