Provider Demographics
NPI:1164578282
Name:SELECT PHYSICAL THERAPY OF KENDALL LTD
Entity Type:Organization
Organization Name:SELECT PHYSICAL THERAPY OF KENDALL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:TARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-975-4503
Mailing Address - Street 1:4716 OLD GETTYSBURG RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-0901
Mailing Address - Country:US
Mailing Address - Phone:717-975-4503
Mailing Address - Fax:717-975-9781
Practice Address - Street 1:11140 SW 88TH ST
Practice Address - Street 2:STE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:305-271-3223
Practice Address - Fax:305-271-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-01-04
Deactivation Date:2007-11-20
Deactivation Code:
Reactivation Date:2008-01-04
Provider Licenses
StateLicense IDTaxonomies
FL261QP2000X
261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106929Medicare Oscar/Certification