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NPI Code Detail

MEDICARE: MICHAEL TRENT SELSOR PT, DPT

MEDICARE: MICHAEL TRENT SELSOR PT, DPT
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
1225100000XPhysical Therapist2016027390MO

General Provider Information

NPI Number : 1710506373
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL TRENT SELSOR PT, DPT
Provider Business Mailing Address
First Line : 1725 S 15TH ST
Second Line :
City : OZARK
State : MO
Zip : 65721-9030
Country : US
Telephone Number : 417-730-5500
Fax Number : 417-730-5505
Provider Business Practice Location Address
First Line : 1725 S 15TH ST
Second Line :
City : OZARK
State : MO
Zip : 65721-9030
Country : US
Telephone Number : 417-730-5500
Fax Number : 417-730-5505
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2020
Last Update Date : 04/14/2020

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