Provider Demographics
NPI:1821588435
Name:SEGO, RICHARD D (LMT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:D
Last Name:SEGO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 INGALLS ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80214-8147
Mailing Address - Country:US
Mailing Address - Phone:172-095-1034
Mailing Address - Fax:
Practice Address - Street 1:500 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-1304
Practice Address - Country:US
Practice Address - Phone:303-388-3735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0015380225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist