Healthcare Provider Details

I. General information

NPI: 1609058502
Provider Name (Legal Business Name): JESSICA LYNN SELOCK P.T., D.P.T., N.C.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 QUEBEC ST BLDG 600
DENVER CO
80230-7144
US

IV. Provider business mailing address

6685 S KELLERMAN WAY
AURORA CO
80016-6164
US

V. Phone/Fax

Practice location:
  • Phone: 303-341-0369
  • Fax: 303-341-0866
Mailing address:
  • Phone: 516-551-3385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number029150-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL0012968
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: