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General NPI Number Information
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NPI Number | 1679017198
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Entity Type | Individual
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Provider Name | JOHN SELINSKI PA-C, AT, ATC
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Gender | Male
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 19000 ST JOES PKWY STE 400
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City | LIVONIA
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State | MI
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Zip | 48152-1477
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Country | US
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Telephone | 866-678-4644
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Fax |
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Provider Business Mailing Address
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Address Line | 24 FRANK LLOYD WRIGHT DR STE J2000
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City | ANN ARBOR
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State | MI
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Zip | 48105-9484
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2601001525
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601011980
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License Number State | MI
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