Individual
KERRY E LANE SELMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
3090 N 3RD AVE, PHOENIX, AZ 85013-4402
(602) 745-2932
(602) 745-2963
Mailing address
30401 N 42ND PL, CAVE CREEK, AZ 85331-3860
(480) 292-6808
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11673
AZ
2251X0800X
Orthopedic Physical Therapist
11673
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
045576
—
AZ
Enumeration date
09/05/2012
Last updated
06/11/2018
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