Provider Demographics
NPI:1023318110
Name:SECONDO, DAVID (LMT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SECONDO
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 1:3300 JOSEPHINE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4157
Mailing Address - Country:US
Mailing Address - Phone:303-886-9483
Mailing Address - Fax:
Practice Address - Street 1:1529 YORK ST
Practice Address - Street 2:SUITE #200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1408
Practice Address - Country:US
Practice Address - Phone:303-886-9483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-24
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9222225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist