MEDICARE: SELECT PHYSICAL THERAPY OF CHICAGO INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1154380137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELECT PHYSICAL THERAPY OF CHICAGO INC

Provider Business Mailing Address
First Line	:	150 E HURON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2999
Country	:	US
Telephone Number	:	312-926-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 E HURON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2999
Country	:	US
Telephone Number	:	312-926-3700
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MICHAEL TARVIN
Credential	:
Telephone Number	:	717-972-1100

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	09/01/2010

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