Provider Demographics
NPI:1619252228
Name:KROUS, SELINA A (LMP)
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:A
Last Name:KROUS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 W MALLON AVE STE 606
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2121
Mailing Address - Country:US
Mailing Address - Phone:509-599-8172
Mailing Address - Fax:
Practice Address - Street 1:621 W. MALLON AVE. SUITE 606
Practice Address - Street 2:HISTORIC FLOUR MILL BLDG.
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201
Practice Address - Country:US
Practice Address - Phone:509-599-8172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60249038225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist