Individual
GINA GRAY SELDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5433 W STATE ROAD 46, SANFORD, FL 32771-9236
(407) 324-7204
(407) 324-7204
Mailing address
503 FREEMAN ST, LONGWOOD, FL 32750-4192
(407) 332-8297
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA12587
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA12587
PHYSICAL THERAPIST ASSIST
FL
Enumeration date
03/29/2007
Last updated
07/08/2007
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