Provider Demographics
NPI:1972384915
Name:SELM, CLARA M (PTA)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:M
Last Name:SELM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
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Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:586-541-3735
Practice Address - Street 1:11215 W 159TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-4416
Practice Address - Country:US
Practice Address - Phone:773-938-8500
Practice Address - Fax:773-938-8501
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL160.009938225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant