Individual
CALLA L. SELFRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT, CMTPT
Contact information
Practice address
204 GUMWOOD DR, SMITHFIELD, VA 23430-6087
(757) 357-7762
(757) 357-7765
Mailing address
PO BOX 69030, BALTIMORE, MD 21264-9030
(757) 873-2302
(757) 873-2306
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305206270
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730415944
—
VA
01
—
9304404
AETNA
VA
01
—
C05954
GROUP MEDICARE PTAN
VA
01
—
P00771554
RAILROAD MEDICARE
VA
Enumeration date
10/22/2009
Last updated
05/03/2018
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