Provider Demographics
NPI:1275800286
Name:COURTNEY-KORO, SELENA CLAIRE (PT)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:CLAIRE
Last Name:COURTNEY-KORO
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 1:951 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-6720
Mailing Address - Country:US
Mailing Address - Phone:248-605-5669
Mailing Address - Fax:
Practice Address - Street 1:14800 W MOUNTAIN VIEW BLVD STE 260
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4797
Practice Address - Country:US
Practice Address - Phone:623-556-5013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIX3310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist