Basic Information
| Provider Information | |||||||||
| NPI: | 1932454154 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SELIGA | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6724 SUMMERS DR W | ||||||||
| Address2: | APT 132 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761376539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035302149 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4060 SANDSHELL DR | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761372422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173069777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2012 | ||||||||
| LastUpdateDate: | 07/14/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1219832 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.