Provider Demographics
NPI:1437010469
Name:CONDELL, SEDA MARIN
Entity type:Individual
Prefix:
First Name:SEDA
Middle Name:MARIN
Last Name:CONDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S DENVER AVE UNIT 11E
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-1340
Mailing Address - Country:US
Mailing Address - Phone:719-221-0389
Mailing Address - Fax:
Practice Address - Street 1:7860 E BERRY PL STE 110
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2326
Practice Address - Country:US
Practice Address - Phone:303-630-9603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0027876225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist