Physiotherapy Associates, Inc.

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

PHYSIOTHERAPY ASSOCIATES, INC.

Practice address

21 Tamal Vista Blvd Ste 113
Corte Madera, CA 94925-1114

Phone

(717) 972-1100

NPI assigned

Jan 15, 2021

Organization subpart

Yes

Parent organization

SELECT MEDICALAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Tarvin

Title

Vice President

Phone

(717) 972-1100

Specialties & licenses 2

Addresses

Other names 1

• Select Physical Therapy Doing business as

Part of

Select Medical Corporation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610668800000",
    "number": "1609465475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4714 GETTYSBURG RD",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170554325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 TAMAL VISTA BLVD STE 113",
            "city": "CORTE MADERA",
            "state": "CA",
            "postal_code": "949251114",
            "telephone_number": "717-972-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSIOTHERAPY ASSOCIATES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SELECT MEDICAL",
        "enumeration_date": "2021-01-15",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A",
        "authorized_official_last_name": "TARVIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "717-972-1100"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Select Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexis Christine Petrakis, PSY.D.
• Nicole Petrosky, PA-C
• Anya Peysakhovich, PA-C
• Kristine L. Pfleiderer, D.M.H.
• Alexandra Phelps, MA
• Jonathan Pofsky, MFT
• Erica Anne Posner, MFT
• Post Street Occupational Medicine PC
• Gordana Potrebic, PSY.D.
• Michael Eric Prentice, CCC-SLP

• Rehabilitation Clinic/Center in Corte Madera, CA
• Providers in Corte Madera, CA by specialty
• Rehabilitation Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.