Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A1084 | MN |
NPI | 1013056613 |
---|---|
Provider Name | Krista Megan Selbitschka |
First Address | Lino Lakes, MN 55014-1458 |
Second Address | Saint Paul, MN 55130-2400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 07/01/2013 |