Provider Demographics
NPI:1871035378
Name:REID, SELINA ANN (ATC/L, MED, NASM-PES)
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:ANN
Last Name:REID
Suffix:
Gender:F
Credentials:ATC/L, MED, NASM-PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 FRIARS POINT RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-9359
Mailing Address - Country:US
Mailing Address - Phone:662-621-4824
Mailing Address - Fax:662-621-4222
Practice Address - Street 1:3240 FRIARS POINT RD
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-9359
Practice Address - Country:US
Practice Address - Phone:662-621-4824
Practice Address - Fax:662-621-4222
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT03252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer