Provider Demographics
NPI:1679689533
Name:SELNER, TRACIE L (MPT)
Entity Type:Individual
Prefix:MISS
First Name:TRACIE
Middle Name:L
Last Name:SELNER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 ZUMBEHL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-2728
Mailing Address - Country:US
Mailing Address - Phone:636-947-7678
Mailing Address - Fax:636-947-4350
Practice Address - Street 1:1840 ZUMBEHL RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-2728
Practice Address - Country:US
Practice Address - Phone:636-947-7678
Practice Address - Fax:636-947-4350
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist