Provider Demographics
NPI:1447028626
Name:SECCO, KIMBERLY M (LMT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:SECCO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:M
Other - Last Name:SOSEBEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:2634 E MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80121-2822
Mailing Address - Country:US
Mailing Address - Phone:720-387-9528
Mailing Address - Fax:
Practice Address - Street 1:2634 E MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80121-2822
Practice Address - Country:US
Practice Address - Phone:720-387-9528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0020143225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist