Provider Demographics
NPI:1801865118
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:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055
Mailing Address - Country:US
Mailing Address - Phone:717-972-1100
Mailing Address - Fax:717-975-9781
Practice Address - Street 1:405 RACETRACK RD NE
Practice Address - Street 2:STE 101
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2561
Practice Address - Country:US
Practice Address - Phone:850-863-4747
Practice Address - Fax:850-863-4658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2010-09-01
Deactivation Date:2007-12-03
Deactivation Code:
Reactivation Date:2008-01-11
Provider Licenses
StateLicense IDTaxonomies
FL261QP2000X
261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106652Medicare Oscar/Certification