Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT023081 | PA |
Y | 2251C2600X | Cardiopulmonary | PT023081 | PA |
NPI | 1467888974 |
---|---|
Provider Name | Dr. Richard Steven Severin |
First Address | Madison, WI 53703-1052 |
Second Address | Madison, WI 53705-2254 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2013 |
Last Update Date | 17/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT023081 | PENNSYLVANNIA PT LICENSE NUMBER (01) | PA |