Provider Demographics
NPI:1306012844
Name:SELECTCARE PHYSICAL THERAPY SERVICES
Entity Type:Organization
Organization Name:SELECTCARE PHYSICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PREETI
Authorized Official - Middle Name:S
Authorized Official - Last Name:VAKHARIYA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:231-937-8485
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:HOWARD CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49329-0256
Mailing Address - Country:US
Mailing Address - Phone:231-937-8485
Mailing Address - Fax:231-937-9836
Practice Address - Street 1:7762 NORTH 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:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MI5501008672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty