Organization
PHYSIOTHERAPY ASSOICATES INC
Active
Other names
NovaCare Kids
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL TARVIN (VICE PRESIDENT)
(717) 972-1100
Entity
Organization
Contact information
Practice address
18 N CATHERINE AVE, LA GRANGE, IL 60525-5930
(708) 482-9453
(708) 482-9454
Mailing address
4714 GETTYSBURG RD, MECHANICSBURG, PA 17055-4325
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1636250
BC/BS PROVIDER #
IL
Enumeration date
10/11/2006
Last updated
12/06/2018
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