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General NPI Number Information
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NPI Number | 1336632298
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Entity Type | Individual
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Provider Name | SEVERINO M TAN DPT
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Gender | Male
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 06/14/2018
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Provider Practice Location Address
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Address Line | 1675 NE LOOP 286
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City | PARIS
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State | TX
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Zip | 75460-2219
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Country | US
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Telephone | 903-782-9922
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Fax | 903-900-4222
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Provider Business Mailing Address
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Address Line | 235 33RD ST SW
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City | PARIS
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State | TX
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Zip | 75460-5369
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Country | US
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Telephone | 903-517-6248
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Fax | 903-900-4222
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1073997
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License Number State | TX
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