Provider Demographics
NPI:1407185176
Name:SELVIDGE, DAWN THERESA (MS, ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:THERESA
Last Name:SELVIDGE
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Gender:F
Credentials:MS, ATC, LAT
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Mailing Address - Street 1:1247 NE 167TH ST
Mailing Address - Street 2:ATTENTION: DAWN SELVIDGE (ATHLETIC TRAINER)
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2723
Mailing Address - Country:US
Mailing Address - Phone:786-525-0362
Mailing Address - Fax:305-949-0491
Practice Address - Street 1:1247 NE 167TH ST
Practice Address - Street 2:ATTENTION: DAWN SELVIDGE (ATHLETIC TRAINER)
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33162-2723
Practice Address - Country:US
Practice Address - Phone:786-525-0362
Practice Address - Fax:305-949-0491
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
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Provider Licenses
StateLicense IDTaxonomies
FLAL 25122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer