Healthcare Provider Details

I. General information

NPI: 1972662278
Provider Name (Legal Business Name): MARK JOSEPH SEVER MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6478 MIRABEL RD
FORESTVILLE CA
95436-1483
US

IV. Provider business mailing address

PO BOX 1483
FORESTVILLE CA
95436-1483
US

V. Phone/Fax

Practice location:
  • Phone: 707-887-0185
  • Fax: 707-887-1681
Mailing address:
  • Phone: 707-887-0185
  • Fax: 707-887-1681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT11388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: