Provider Demographics
NPI:1679397889
Name:TRAN, SELENA (PT, DPT)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 CIVIC DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1946
Mailing Address - Country:US
Mailing Address - Phone:925-284-6150
Mailing Address - Fax:
Practice Address - Street 1:3658 MT DIABLO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-6828
Practice Address - Country:US
Practice Address - Phone:925-284-6150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT307263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist