Organization
SELECT PHYSICAL THERAPY OF ILLINOIS LIMITED PARTNERSHIP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL E TARVIN (VICE PRESIDENT)
(717) 972-1100
Entity
Organization
Contact information
Practice address
820 E TERRA COTTA AVE, STE 102, CRYSTAL LAKE, IL 60014
(815) 455-3262
(815) 455-2729
Mailing address
4714 GETTYSBURG RD, MECHANICSBURG, PA 17055-4325
(717) 972-1100
(717) 975-9781
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
IL
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Enumeration date
03/20/2006
Last updated
09/01/2010
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