Provider Demographics
NPI:1407046923
Name:SELBY, BRENDA ANNE (PT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANNE
Last Name:SELBY
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 1:12 CLEARVIEW CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1705
Mailing Address - Country:US
Mailing Address - Phone:717-476-6300
Mailing Address - Fax:
Practice Address - Street 1:12 CLEARVIEW CT
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1705
Practice Address - Country:US
Practice Address - Phone:717-476-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17083174400000X
PAPT004142E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist