Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 00000997 | WA |
NPI | 1104062538 |
---|---|
Provider Name | Mr. John Henry Selden |
First Address | Tacoma, WA 98408-1317 |
Second Address | Tacoma, WA 98408-1317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2009 |
Last Update Date | 07/01/2009 |