Provider Demographics
NPI:1952686065
Name:SELBY, AMY CHRISTINE (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTINE
Last Name:SELBY
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 1:10483 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-9311
Mailing Address - Country:US
Mailing Address - Phone:810-771-7686
Mailing Address - Fax:810-771-7685
Practice Address - Street 1:10483 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-9311
Practice Address - Country:US
Practice Address - Phone:810-771-7686
Practice Address - Fax:810-771-7685
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist