Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1326156589 |
---|---|
Provider Name | Mr. Neal Jay Severance |
First Address | Simi Valley, CA 93063-4534 |
Second Address | North Hills, CA 91343-2036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 08/07/2007 |