Healthcare Provider Details

I. General information

NPI: 1568474476
Provider Name (Legal Business Name): JANET SELBY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4018 N 40TH ST
PHOENIX AZ
85018-5205
US

IV. Provider business mailing address

4018 N 40TH ST
PHOENIX AZ
85018-5205
US

V. Phone/Fax

Practice location:
  • Phone: 602-955-0551
  • Fax: 602-956-8269
Mailing address:
  • Phone: 602-955-0551
  • Fax: 602-956-8269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-02073P
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: