Provider Demographics
NPI:1821756529
Name:SELWYN, MELISSIA C (LPTA)
Entity Type:Individual
Prefix:MS
First Name:MELISSIA
Middle Name:C
Last Name:SELWYN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 NASSAU RD
Mailing Address - Street 2:
Mailing Address - City:FINCASTLE
Mailing Address - State:VA
Mailing Address - Zip Code:24090-4379
Mailing Address - Country:US
Mailing Address - Phone:815-219-8029
Mailing Address - Fax:
Practice Address - Street 1:3365 OGDEN RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1151
Practice Address - Country:US
Practice Address - Phone:540-682-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602958225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant