Provider Demographics
NPI:1851785844
Name:DUFF, SELENA (PTA)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:DUFF
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:SELENA
Other - Middle Name:JOHNSON
Other - Last Name:DUFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:2830 PHILLIPS ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35633-1525
Mailing Address - Country:US
Mailing Address - Phone:256-762-3362
Mailing Address - Fax:
Practice Address - Street 1:2830 PHILLIPS ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35633-1525
Practice Address - Country:US
Practice Address - Phone:256-762-3362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL347314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility