1346219235 NPI number — SELECT PHYSICAL THERAPY BAPTIST REHABILITATION CENTER LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346219235 NPI number — SELECT PHYSICAL THERAPY BAPTIST REHABILITATION CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SELECT PHYSICAL THERAPY BAPTIST REHABILITATION CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346219235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
10/29/2007
NPI Reactivation Date:
12/13/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4716 OLD GETTYSBURG RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-975-9503
Provider Business Mailing Address Fax Number:
717-975-9981

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
635 MCQUEEN SMITH RD N
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
PRATTVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-365-8063
Provider Business Practice Location Address Fax Number:
334-365-7905
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TARVIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
717-975-4503

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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