Provider Demographics
NPI:1760291983
Name:SELBY MEDICAL MASSAGE LLC
Entity type:Organization
Organization Name:SELBY MEDICAL MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SELBY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CNMT, CMMP
Authorized Official - Phone:480-382-2537
Mailing Address - Street 1:952 S 96TH PL
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-3110
Mailing Address - Country:US
Mailing Address - Phone:714-315-7306
Mailing Address - Fax:
Practice Address - Street 1:4111 E VALLEY AUTO DR STE 201
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4609
Practice Address - Country:US
Practice Address - Phone:480-382-2537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty