Provider Demographics
NPI:1235811365
Name:SENG, ELEXIA LISETTE
Entity Type:Individual
Prefix:
First Name:ELEXIA
Middle Name:LISETTE
Last Name:SENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 W 120TH AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2406
Mailing Address - Country:US
Mailing Address - Phone:720-768-3381
Mailing Address - Fax:
Practice Address - Street 1:6363 W 120TH AVE STE 310
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2406
Practice Address - Country:US
Practice Address - Phone:720-768-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0022525225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty