Provider Demographics
NPI:1710200340
Name:BARBOSA, SELMA APARECIDA MARTINS (PTA)
Entity Type:Individual
Prefix:
First Name:SELMA
Middle Name:APARECIDA MARTINS
Last Name:BARBOSA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MAIN STREET
Mailing Address - Street 2:APT# 2
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960
Mailing Address - Country:US
Mailing Address - Phone:816-262-3925
Mailing Address - Fax:
Practice Address - Street 1:106 MAIN ST APT 2
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-8327
Practice Address - Country:US
Practice Address - Phone:816-262-3925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8198225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant