Provider Demographics
NPI:1518109776
Name:MORGAN, SELINA MENDIETA (PT, ATP)
Entity Type:Individual
Prefix:MRS
First Name:SELINA
Middle Name:MENDIETA
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PT, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7979 WURZBACH RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4427
Mailing Address - Country:US
Mailing Address - Phone:210-450-1000
Mailing Address - Fax:210-450-2117
Practice Address - Street 1:7979 WURZBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4427
Practice Address - Country:US
Practice Address - Phone:210-450-1000
Practice Address - Fax:210-450-2117
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1047819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209811305OtherCSHCN
TX209811304Medicaid