Healthcare Provider Details

I. General information

NPI: 1962166629
Provider Name (Legal Business Name): VIVE PHYSIOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2342 DOGWOOD DR
ERIE CO
80516-7933
US

IV. Provider business mailing address

2342 DOGWOOD DR
ERIE CO
80516-7933
US

V. Phone/Fax

Practice location:
  • Phone: 970-988-9804
  • Fax:
Mailing address:
  • Phone: 970-988-9804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIELLE NICOLE SELBY
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 970-988-9804