Healthcare Provider Details

I. General information

NPI: 1801703640
Provider Name (Legal Business Name): SAMANTHA ANN SELVITELLI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W UNION ST
ASHLAND MA
01721-1499
US

IV. Provider business mailing address

59 BRANTWOOD RD
WORCESTER MA
01602-1771
US

V. Phone/Fax

Practice location:
  • Phone: 508-767-5149
  • Fax:
Mailing address:
  • Phone: 774-329-7307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL90040
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: