Provider Demographics
NPI:1164708053
Name:SELLENS, DEENA PORTNOFF (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEENA
Middle Name:PORTNOFF
Last Name:SELLENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22995 MILL CREEK DR STE A
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1215
Mailing Address - Country:US
Mailing Address - Phone:949-707-5555
Mailing Address - Fax:
Practice Address - Street 1:22995 MILL CREEK DR STE A
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1215
Practice Address - Country:US
Practice Address - Phone:949-707-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist