MEDICARE: MRS. SELENA NICOLE BELDZIK PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0009524	CO

General Provider Information

NPI Number	:	1295898443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SELENA NICOLE BELDZIK PT

Provider Business Mailing Address
First Line	:	2255 SABLE CHASE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-6712
Country	:	US
Telephone Number	:	719-266-4625
Fax Number	:

Provider Business Practice Location Address
First Line	:	2255 SABLE CHASE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-6712
Country	:	US
Telephone Number	:	719-266-4625
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	06/21/2013

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