Active NPI
Gina Gray Selders, PTA
- Physical Therapy Assistant
- Sanford, FL
National Provider Identifier
1689793606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA12587
- Practice address
- 5433 W State Road 46
Sanford, FL 32771-9236 - Phone
- (407) 324-7204
- Fax
- (407) 324-7204
- NPI assigned
- Mar 29, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA12587 | FL | Primary |
Addresses
Primary practice location
5433 W State Road 46
Sanford, FL 32771-9236
Mailing address
503 Freeman St
Longwood, FL 32750-4192
Phone (407) 332-8297
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PTA12587 | Other | FL | PHYSICAL THERAPIST ASSIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA12587 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689793606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "503 FREEMAN ST",
"city": "LONGWOOD",
"state": "FL",
"postal_code": "327504192",
"telephone_number": "407-332-8297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5433 W STATE ROAD 46",
"city": "SANFORD",
"state": "FL",
"postal_code": "327719236",
"telephone_number": "407-324-7204",
"fax_number": "407-324-7204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SELDERS",
"first_name": "GINA",
"middle_name": "GRAY",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "PTA12587",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICAL THERAPIST ASSIST",
"identifier": "PTA12587",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sanford, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.