Selena Phan, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

052960 Issued in NY

Practice address

475 Northern Blvd
Great Neck, NY 11021-4819

Phone

(516) 466-7723

Fax

(516) 466-7723

NPI assigned

Aug 26, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

State Un of Ny, Stony Brook School of Dental Med, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ivyrehab Physical Therapy, Occupational Therapy and Speech Language PAGroup PAC ID 7012997638, 385 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path

  • Physical Therapist
  • Harrison, NY
  • NPI 1396799409
  Medicare reassignment Care Compare group NPD
• Reddy Care Physical Therapy PC

  • Specialist
  • Great Neck, NY
  • NPI 1932171097

  Physical Therapist

  Medicare reassignment NPD
• Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC

  • Physical Medicine & Rehabilitation Physician
  • New York, NY
  • NPI 1215637699
  NPD
• Link Home Therapy Services of Ny-PT OT SLP PLLC

  • Physical Therapy Clinic/Center
  • Valley Stream, NY
  • NPI 1942782966
  NPD (past)
• Hearusa Inc

  • Audiologist-Hearing Aid Fitter
  • West Palm Beach, FL
  • NPI 1073560231
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1972336733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 LOUIS ST UNIT 1",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118015361",
            "telephone_number": "516-697-0143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 NORTHERN BLVD",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214819",
            "telephone_number": "516-466-7723",
            "fax_number": "516-466-7723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "SELENA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-26",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "052960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elena Nicole Petkanas
• Tamara Jean Petrazzi, DPT
• Ashley Marie Petrillo
• Denise Petrizzi, NP
• Patricia Pezzello, MD
• Pharmacena LLC
• Pharmatopia Inc
• Huai Lee Phen, M.D
• Philip Ragone M D P C
• Philip Ragone, M.D., P.C.

• Physical Therapist in Great Neck, NY
• Providers in Great Neck, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.