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General NPI Number Information
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NPI Number | 1225715642
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Entity Type | Individual
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Provider Name | MATTHEW SCOTT SELLERS CMT, IFSP
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Gender | Male
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Dates
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Enumeration Date | 06/28/2023
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 373 BLAIR PARK RD
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City | WILLISTON
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State | VT
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Zip | 05495-8037
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Country | US
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Telephone | 802-595-2338
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Fax |
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Provider Business Mailing Address
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Address Line | 110 PERKINS RD
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City | MONTPELIER
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State | VT
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Zip | 05602-9452
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Country | US
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Telephone | 802-595-2338
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 164.0000471
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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