Provider Demographics
NPI:1215983341
Name:SELCHER, KRISTA K (MPT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:K
Last Name:SELCHER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:A
Other - Last Name:KONDRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:403 HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3409 W CHESTER PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4227
Practice Address - Country:US
Practice Address - Phone:610-353-6624
Practice Address - Fax:610-353-2568
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015996174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1828988OtherBLUE SHIELD
PA1828988OtherBLUE SHIELD