Provider Demographics
NPI:1386037828
Name:SELECT PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SELECT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-361-7603
Mailing Address - Street 1:301 W 10TH ST
Mailing Address - Street 2:APT101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-1739
Mailing Address - Country:US
Mailing Address - Phone:614-361-7603
Mailing Address - Fax:
Practice Address - Street 1:301 W 10TH ST
Practice Address - Street 2:APT101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-1739
Practice Address - Country:US
Practice Address - Phone:614-361-7603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15449261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy