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General NPI Number Information
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NPI Number | 1013056613
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Entity Type | Individual
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Provider Name | KRISTA MEGAN SELBITSCHKA PTA
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Gender | Female
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 295 PHALEN BLVD
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City | SAINT PAUL
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State | MN
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Zip | 55130-2400
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Country | US
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Telephone | 651-524-0719
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Fax | 651-254-3212
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Provider Business Mailing Address
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Address Line | 6437 TOMAHAWK TRL
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City | LINO LAKES
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State | MN
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Zip | 55014-1458
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A1084
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License Number State | MN
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