Healthcare Provider Details

I. General information

NPI: 1073216123
Provider Name (Legal Business Name): SELENA BRITTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 EASTERN BLVD
MONTGOMERY AL
36117-1607
US

IV. Provider business mailing address

117 CAPRI DR
MONTGOMERY AL
36117-3703
US

V. Phone/Fax

Practice location:
  • Phone: 334-590-8594
  • Fax:
Mailing address:
  • Phone: 334-590-8594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: