Provider Demographics
NPI:1720295942
Name:SELWYN, EVA GAY (LPTA)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:GAY
Last Name:SELWYN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-1244
Mailing Address - Country:US
Mailing Address - Phone:540-459-5940
Mailing Address - Fax:
Practice Address - Street 1:315 E LEE HWY
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:VA
Practice Address - Zip Code:22844-3103
Practice Address - Country:US
Practice Address - Phone:540-740-8041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306001242225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant