Healthcare Provider Details

I. General information

NPI: 1609386309
Provider Name (Legal Business Name): RACHEL SELINA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2017
Last Update Date: 10/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 S HURON ST
YPSILANTI MI
48197-9701
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 734-483-9200
  • Fax: 734-483-9202
Mailing address:
  • Phone: 810-632-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501018398
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: