Provider Demographics
NPI:1194794743
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:17055-4325
Mailing Address - Country:US
Mailing Address - Phone:717-972-1100
Mailing Address - Fax:717-975-9781
Practice Address - Street 1:3535 W 12TH ST
Practice Address - Street 2:STE E
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2557
Practice Address - Country:US
Practice Address - Phone:970-353-7935
Practice Address - Fax:970-353-2906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2010-08-31
Deactivation Date:2007-11-07
Deactivation Code:
Reactivation Date:2007-12-13
Provider Licenses
StateLicense IDTaxonomies
CO261QP2000X
261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066592Medicare Oscar/Certification