Provider Demographics
NPI:1003193418
Name:SELWA, JOLENE SHARILYN (PTA)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:SHARILYN
Last Name:SELWA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 HAPPY WOODS CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-2925
Mailing Address - Country:US
Mailing Address - Phone:843-293-2246
Mailing Address - Fax:843-293-2247
Practice Address - Street 1:3620 HAPPY WOODS CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-2925
Practice Address - Country:US
Practice Address - Phone:843-293-2246
Practice Address - Fax:843-293-2247
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2373225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant