Provider Demographics
NPI:1306208384
Name:SELIMO, PAULETTE (DPT)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:
Last Name:SELIMO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 GRASSLAND PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8601
Mailing Address - Country:US
Mailing Address - Phone:678-580-1404
Mailing Address - Fax:
Practice Address - Street 1:1755 GRASSLAND PKWY STE B
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-8601
Practice Address - Country:US
Practice Address - Phone:678-580-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01574700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist