Healthcare Provider Details

I. General information

NPI: 1508742008
Provider Name (Legal Business Name): MICHAEL SELLECK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 MARSHALL DR STE 210
LENEXA KS
66214-9836
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 913-492-0333
  • Fax:
Mailing address:
  • Phone: 726-202-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-04326
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: