Provider Demographics
NPI:1255050837
Name:WOODHAM, SELINA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SELINA
Middle Name:
Last Name:WOODHAM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SELINA
Other - Middle Name:
Other - Last Name:YAMANE WOODHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1851 STEAMBOAT PKWY UNIT 7906
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-6377
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:645 E CALAVERAS BLVD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-7705
Practice Address - Country:US
Practice Address - Phone:408-325-6251
Practice Address - Fax:408-325-6281
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT302258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist