MEDICARE: SEDA MARIN CONDELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	0027876	CO

General Provider Information

NPI Number	:	1437010469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEDA MARIN CONDELL

Provider Business Mailing Address
First Line	:	500 S DENVER AVE UNIT 11E
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-1340
Country	:	US
Telephone Number	:	719-221-0389
Fax Number	:

Provider Business Practice Location Address
First Line	:	7860 E BERRY PL STE 110
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2326
Country	:	US
Telephone Number	:	303-630-9603
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2025
Last Update Date	:	11/19/2025

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