Organization
SSM SELECT REHAB ST LOUIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL E. TARVIN (VICE PRESIDENT)
(717) 972-1100
Entity
Organization
Contact information
Practice address
1027 BELLEVUE AVENUE, RICHMOND HEIGHTS, MO 63117
(314) 768-8000
Mailing address
4714 GETTYSBURG RD, ATTN LEGAL DEPARTMENT, MECHANICSBURG, PA 17055-4325
(717) 972-1100
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
02/12/2007
Last updated
10/07/2011
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