Provider Demographics
NPI:1720019730
Name:SELTEN, PETER ERNEST (PT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ERNEST
Last Name:SELTEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7625 PARAGON RD
Mailing Address - Street 2:STE A
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4063
Mailing Address - Country:US
Mailing Address - Phone:937-424-5607
Mailing Address - Fax:937-435-8486
Practice Address - Street 1:7625 PARAGON RD
Practice Address - Street 2:STE A
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4063
Practice Address - Country:US
Practice Address - Phone:937-424-5607
Practice Address - Fax:937-435-8486
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-003878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHQ44833Medicare UPIN