Provider Demographics
NPI:1225010879
Name:SELECT THERAPY AND REHABILITATION SERVICES
Entity Type:Organization
Organization Name:SELECT THERAPY AND REHABILITATION SERVICES
Other - Org Name:SELECT THERAPY AND REHAB
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WAGGONER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS, MTC
Authorized Official - Phone:954-443-3996
Mailing Address - Street 1:3157 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2258
Mailing Address - Country:US
Mailing Address - Phone:954-443-3996
Mailing Address - Fax:954-443-3994
Practice Address - Street 1:3157 N UNIVERSITY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-2258
Practice Address - Country:US
Practice Address - Phone:954-443-3996
Practice Address - Fax:954-443-3994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL 18303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty