Provider Demographics
NPI:1881165090
Name:SELGA, JOHN JEMUJEFF CHUA (DPT)
Entity type:Individual
Prefix:
First Name:JOHN JEMUJEFF
Middle Name:CHUA
Last Name:SELGA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 KENMOOR AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2395
Mailing Address - Country:US
Mailing Address - Phone:616-356-5000
Mailing Address - Fax:616-356-5001
Practice Address - Street 1:1075 S IDAHO RD STE 210
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85119-6405
Practice Address - Country:US
Practice Address - Phone:480-983-0877
Practice Address - Fax:480-983-3172
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-30626225100000X
AZIP-18-08225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZIP-18-08OtherARIZONA BOARD