Provider Demographics
NPI:1659331163
Name:SELECT PHYSICAL THERAPY HOLDINGS INC
Entity Type:Organization
Organization Name:SELECT PHYSICAL THERAPY HOLDINGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-972-1100
Mailing Address - Street 1:615 S HUGHES BLVD
Mailing Address - Street 2:UNIT B
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4785
Mailing Address - Country:US
Mailing Address - Phone:252-335-2087
Mailing Address - Fax:
Practice Address - Street 1:615 S HUGHES BLVD
Practice Address - Street 2:UNIT B
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4785
Practice Address - Country:US
Practice Address - Phone:252-335-2087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC346616Medicare Oscar/Certification