Provider Demographics
NPI:1578504361
Name:SELECT MEDICAL
Entity Type:Organization
Organization Name:SELECT MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:443-554-1105
Mailing Address - Street 1:5057 WOODS LINE DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-2650
Mailing Address - Country:US
Mailing Address - Phone:443-554-1105
Mailing Address - Fax:410-683-2115
Practice Address - Street 1:6565 N CHARLES ST
Practice Address - Street 2:SUITE 514
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6800
Practice Address - Country:US
Practice Address - Phone:410-828-0600
Practice Address - Fax:410-828-5099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20774261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy