Provider Demographics
NPI:1073611638
Name:SELLON, DANIEL J (MPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:SELLON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5285
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5285
Mailing Address - Country:US
Mailing Address - Phone:308-382-0344
Mailing Address - Fax:308-382-3241
Practice Address - Street 1:1601 N 86TH ST
Practice Address - Street 2:STE 300
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-3713
Practice Address - Country:US
Practice Address - Phone:402-327-7515
Practice Address - Fax:402-327-7513
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39558OtherBCBS
280662Medicare ID - Type Unspecified