=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669775565
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDY SELMAN PT, CHT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2010
-----------------------------------------------------
Last Update Date | 12/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 322 N CENTRAL AVE
-----------------------------------------------------
City | EUREKA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63025-1826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-938-4065
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16750 CHESTERFIELD MANOR DR
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63005-1647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 08150
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2251H1200X
-----------------------------------------------------
Taxonomy Name | Hand Physical Therapist
-----------------------------------------------------
License Number | 08150
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------