Provider Demographics
NPI:1679055479
Name:SELVA, JUSTIN ARMANDO (DPT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ARMANDO
Last Name:SELVA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4812 BLUFFTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910
Mailing Address - Country:US
Mailing Address - Phone:843-837-5236
Mailing Address - Fax:843-837-1004
Practice Address - Street 1:4812 BLUFFTON PKWY
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910
Practice Address - Country:US
Practice Address - Phone:843-837-5236
Practice Address - Fax:843-837-1004
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17892225100000X
GACP008272T225100000X
SC8980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist