Provider Demographics
NPI:1730501982
Name:ESOP REHABILITATION, LLC
Entity Type:Organization
Organization Name:ESOP REHABILITATION, LLC
Other - Org Name:EMORY & SELECT PHYSICAL THERAPY
Other - Org Type:Doing Business As
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:
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:717-975-9981
Practice Address - Street 1:4450 HUGH HOWELL RD
Practice Address - Street 2:STE 9
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4917
Practice Address - Country:US
Practice Address - Phone:770-939-0998
Practice Address - Fax:770-939-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy