Individual
SELINA LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5152 TRUEMPER WAY, APT 5, FORT WAYNE, IN 46835-3268
(574) 265-3819
Mailing address
5152 TRUEMPER WAY, APT 5, FORT WAYNE, IN 46835-3268
(574) 265-3819
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06004696A
IN
Other
Enumeration date
08/26/2013
Last updated
08/26/2013
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