Provider Demographics
NPI:1376282186
Name:SELVERA, EMILY RENEE (PT,DPT)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:RENEE
Last Name:SELVERA
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:RENEE
Other - Last Name:ABALOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:620 N ALLEGHANEY AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4408
Mailing Address - Country:US
Mailing Address - Phone:432-332-8244
Mailing Address - Fax:432-580-7428
Practice Address - Street 1:620 N ALLEGHANEY AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4408
Practice Address - Country:US
Practice Address - Phone:432-332-8244
Practice Address - Fax:432-580-7428
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1361214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1361214OtherTEXAS BOARD OF PHYSICAL THERAPY EXAMINERS