Provider Demographics
NPI:1164536108
Name:SELECT CARE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:SELECT CARE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PROMODH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:231-937-8485
Mailing Address - Street 1:7762 N FEDERAL ROAD
Mailing Address - Street 2:P.O.BOX256
Mailing Address - City:HOWARDCITY
Mailing Address - State:MI
Mailing Address - Zip Code:49329
Mailing Address - Country:US
Mailing Address - Phone:231-937-8485
Mailing Address - Fax:231-937-9836
Practice Address - Street 1:7762 N FEDERAL ROAD
Practice Address - Street 2:
Practice Address - City:HOWARDCITY
Practice Address - State:MI
Practice Address - Zip Code:49329
Practice Address - Country:US
Practice Address - Phone:231-937-8485
Practice Address - Fax:231-937-9836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonaryGroup - Single Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P18050Medicare ID - Type UnspecifiedGROUP NUMBER