Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 35355 | CA |
NPI | 1023412590 |
---|---|
Provider Name | Oliver Severios |
First Address | Redondo Beach, CA 90277-5326 |
Second Address | Redondo Beach, CA 90277-5326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2014 |
Last Update Date | 13/10/2014 |