Provider Demographics
NPI:1801134937
Name:SELTZ, STEPHEN RICHARD (PT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:RICHARD
Last Name:SELTZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E SARNIA ST
Mailing Address - Street 2:WINONA MN
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6365
Mailing Address - Country:US
Mailing Address - Phone:507-457-4535
Mailing Address - Fax:507-453-3791
Practice Address - Street 1:109 W JESSE ST
Practice Address - Street 2:RUSHFORD CLINIC
Practice Address - City:RUSHFORD
Practice Address - State:MN
Practice Address - Zip Code:55971
Practice Address - Country:US
Practice Address - Phone:507-864-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist