Provider Demographics
NPI:1639498421
Name:FORGEY, SELENA ANN (LMP)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:ANN
Last Name:FORGEY
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 1:10909 PORTLAND AVE E
Mailing Address - Street 2:SUITE F
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445
Mailing Address - Country:US
Mailing Address - Phone:253-535-1349
Mailing Address - Fax:
Practice Address - Street 1:10909 PORTLAND AVE E
Practice Address - Street 2:SUITE F
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445
Practice Address - Country:US
Practice Address - Phone:253-535-1349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00020744225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist