Provider Demographics
NPI:1700849726
Name:SELECT PHYSICAL THERAPY TEXAS LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:SELECT PHYSICAL THERAPY TEXAS LIMITED PARTNERSHIP
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 1:3700 W 15TH ST
Mailing Address - Street 2:BLDG B STE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-4736
Mailing Address - Country:US
Mailing Address - Phone:972-867-7675
Mailing Address - Fax:
Practice Address - Street 1:3700 W 15TH ST
Practice Address - Street 2:BLDG B STE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4736
Practice Address - Country:US
Practice Address - Phone:972-867-7675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
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
TX676505Medicare Oscar/Certification