Provider Demographics
NPI:1518250661
Name:SELOVER, RENEE TONAZZI
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:TONAZZI
Last Name:SELOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 ROBY AVE
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-1800
Mailing Address - Country:US
Mailing Address - Phone:315-434-3830
Mailing Address - Fax:315-434-3831
Practice Address - Street 1:303 ROBY AVE
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-1800
Practice Address - Country:US
Practice Address - Phone:315-434-3830
Practice Address - Fax:315-434-3831
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025000-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist