| NPI |
1992389019 |
The fax number associated with the location
address of the provider being identified. |
| Entity Type Code |
2 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Employer Identification Number EIN |
|
The date that a record was last updated or changed. |
| Provider Organization Name Legal Business Name |
SELECT CS PHYSICAL THERAPY, P.C. |
The code designating the provider’s gender if the provider is a person. |
| Provider Other Organization Name |
SELECT PHYSICAL THERAPY |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Provider Other Organization Name Type Code |
3 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider First Line Business Practice Location Address |
18800 DELAWARE ST STE 350 |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Provider Business Practice Location Address City Name |
HUNTINGTON BEACH |
|
| Provider Business Practice Location Address State Name |
CA |
The State code in the location of the provider
being identified. |
| Provider Business Practice Location Address Postal Code |
926486084 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address Telephone Number |
7148488318 |
The telephone number associated with the location address of the provider being identified. |
| Provider Business Practice Location Address Fax Number |
7148488306 |
The fax number associated with the location
address of the provider being identified. |
| Provider Enumeration Date |
5/6/2021 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Last Update Date |
6/14/2023 |
|
| Authorized Official Last Name |
TARVIN |
|
| Authorized Official First Name |
MICHAEL |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
| Authorized Official Title or Position |
VICE PRESIDENT |
The title or position of the authorized official. |
| Authorized Official Telephone Number |
7179721100 |
The 10-position telephone number of the authorized official. |
| Healthcare Provider Taxonomy Code 1 |
261QR0400X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
| Healthcare Provider Taxonomy Code 2 |
261QP2000X |
|
| Healthcare Provider Primary Taxonomy Switch 2 |
Y |
|
| Is Organization Subpart |
N |
|
| NPI Certification Date |
6/14/2023 |
|