Provider Demographics
NPI:1255354809
Name:SELIG, MICHAEL M (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:M
Last Name:SELIG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12516 HILLTOP MILL RD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-7645
Mailing Address - Country:US
Mailing Address - Phone:609-375-7100
Mailing Address - Fax:
Practice Address - Street 1:12516 HILLTOP MILL RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-3327
Practice Address - Country:US
Practice Address - Phone:609-375-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12029225100000X
TX1390979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1390979OtherPHYSICAL THERAPY LICENSE
FLPT12029OtherPHYSICAL THERAPY LICENSE