MEDICARE: MR. SEVERO BATION SIASOYCO II P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0024	MP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396012696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SEVERO BATION SIASOYCO II P.T.

Provider Business Mailing Address
First Line	:	2489 LADOGA DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-9540
Country	:	US
Telephone Number	:	863-617-3332
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 MORGAN WIELAND LN
Second Line	:	APT 202
City	:	LAKELAND
State	:	FL
Zip	:	33813-3181
Country	:	US
Telephone Number	:	863-617-3332
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	09/14/2021

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