Provider Demographics
NPI:1689634131
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:E
Authorized Official - Last Name:TARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-972-1100
Mailing Address - Street 1:4714 GETTYSBURG RD
Mailing Address - Street 2:LEGAL DPT
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4325
Mailing Address - Country:US
Mailing Address - Phone:717-972-1100
Mailing Address - Fax:717-975-9781
Practice Address - Street 1:60 MARIE AVE E
Practice Address - Street 2:STE 105, 2ND FLOOR
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-5910
Practice Address - Country:US
Practice Address - Phone:651-451-6156
Practice Address - Fax:651-451-0387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2023-08-30
Deactivation Date:2007-11-20
Deactivation Code:
Reactivation Date:2008-01-04
Provider Licenses
StateLicense IDTaxonomies
MN261QP2000X
261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN246574Medicare Oscar/Certification