Healthcare Provider Details

I. General information

NPI: 1790055036
Provider Name (Legal Business Name): SEVER EFFECTIVENESS STRATEGIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6478 MIRABEL ROAD
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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT11388
License Number StateCA

VIII. Authorized Official

Name: MR. MARK JOSEPH SEVER
Title or Position: SECRETARY
Credential: PT
Phone: 707-887-0185