Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2373 | SC |
NPI | 1003193418 |
---|---|
Provider Name | Jolene Sharilyn Selwa |
First Address | Myrtle Beach, SC 29588-2925 |
Second Address | Myrtle Beach, SC 29588-2925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2011 |
Last Update Date | 14/11/2011 |