Provider Demographics
NPI:1982803045
Name:TANTUM, SENECA WEBB (PT)
Entity Type:Individual
Prefix:MS
First Name:SENECA
Middle Name:WEBB
Last Name:TANTUM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SENCA
Other - Middle Name:L
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4645 KIRKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-4235
Mailing Address - Country:US
Mailing Address - Phone:720-951-0481
Mailing Address - Fax:303-447-3390
Practice Address - Street 1:295 BROKEN FENCE RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-9607
Practice Address - Country:US
Practice Address - Phone:303-601-6666
Practice Address - Fax:303-447-3390
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9678OtherPT LICENSE
CO9678OtherPT LICENSE