Provider Demographics
NPI:1477988228
Name:QUIROGA, SELENE S (PT)
Entity Type:Individual
Prefix:MRS
First Name:SELENE
Middle Name:S
Last Name:QUIROGA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17929 SKYMEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20860-1032
Mailing Address - Country:US
Mailing Address - Phone:240-280-4060
Mailing Address - Fax:
Practice Address - Street 1:3311 TOLEDO TERRACE
Practice Address - Street 2:SUITE A1
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-4136
Practice Address - Country:US
Practice Address - Phone:301-853-0093
Practice Address - Fax:301-853-0096
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD24480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist