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General NPI Number Information
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NPI Number | 1427232461
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Entity Type | Individual
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Provider Name | ERIC JOSEPH SUPNET SEVIDAL
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Gender | Male
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 3290 EXECUTIVE CENTER II CAMBRIDGE HEALTHCARE NORTH RIDGE
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City | ELLICOTT
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State | MD
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Zip | 21043
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Country | US
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Telephone | 410-750-9006
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Fax |
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Provider Business Mailing Address
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Address Line | 172 MANZANITA PL
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City | HERCULES
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State | CA
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Zip | 94547-1161
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Country | US
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Telephone | 510-245-1252
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | NC
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