Provider Demographics
NPI:1811033566
Name:SELKE, AUDREY JANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:JANE
Last Name:SELKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 STONE POINT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47620-7364
Mailing Address - Country:US
Mailing Address - Phone:812-985-0790
Mailing Address - Fax:
Practice Address - Street 1:150 N ROSENBERGER AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-6503
Practice Address - Country:US
Practice Address - Phone:812-477-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002331A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist