Provider Demographics
NPI:1215256144
Name:SELLARD, TRACY (CMT, RMT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SELLARD
Suffix:
Gender:F
Credentials:CMT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 E 12TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-3434
Mailing Address - Country:US
Mailing Address - Phone:303-377-2048
Mailing Address - Fax:303-432-8887
Practice Address - Street 1:3570 E 12TH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-3434
Practice Address - Country:US
Practice Address - Phone:303-377-2048
Practice Address - Fax:303-432-8887
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO741172M00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist