Healthcare Provider Details

I. General information

NPI: 1225715642
Provider Name (Legal Business Name): MATTHEW SCOTT SELLERS CMT, IFSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 BLAIR PARK RD
WILLISTON VT
05495-8037
US

IV. Provider business mailing address

110 PERKINS RD
MONTPELIER VT
05602-9452
US

V. Phone/Fax

Practice location:
  • Phone: 802-595-2338
  • Fax:
Mailing address:
  • Phone: 802-595-2338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number164.0000471
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: