Provider Demographics
NPI:1962463661
Name:SELECT PHYSICAL THERAPY OF LORAIN LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:SELECT PHYSICAL THERAPY OF LORAIN 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:717-975-4503
Mailing Address - Street 1:1909 N RIDGE RD E
Mailing Address - Street 2:UNIT 3
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-3379
Mailing Address - Country:US
Mailing Address - Phone:440-277-9101
Mailing Address - Fax:
Practice Address - Street 1:1909 N RIDGE RD E
Practice Address - Street 2:UNIT 3
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-3379
Practice Address - Country:US
Practice Address - Phone:440-277-9101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH366586Medicare ID - Type UnspecifiedPROVIDER NUMBER