Healthcare Provider Details

I. General information

NPI: 1669775565
Provider Name (Legal Business Name): WENDY SELMAN PT, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 N CENTRAL AVE
EUREKA MO
63025-1826
US

IV. Provider business mailing address

16750 CHESTERFIELD MANOR DR
CHESTERFIELD MO
63005-1647
US

V. Phone/Fax

Practice location:
  • Phone: 636-938-4065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number08150
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number08150
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: