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General NPI Number Information
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NPI Number | 1700543204
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Entity Type | Individual
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Provider Name | JOHN THOMAS SELMAN III ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 11/19/2021
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 210 LINDSEY WILSON ST
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City | COLUMBIA
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State | KY
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Zip | 42728-1298
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Country | US
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Telephone | 270-384-8070
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Fax | 270-384-8078
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Provider Business Mailing Address
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Address Line | 803 HUGHES ST APT 207
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City | COLUMBIA
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State | KY
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Zip | 42728-1079
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Country | US
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Telephone | 270-723-4067
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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 | TCA027
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License Number State | KY
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