Basic Information
| Provider Information | |||||||||
| NPI: | 1326156589 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEVERANCE | ||||||||
| FirstName: | NEAL | ||||||||
| MiddleName: | JAY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RKT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5275 MILDRED ST | ||||||||
| Address2: | |||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930634534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055816159 | ||||||||
| FaxNumber: | 8053065934 | ||||||||
| Practice Location | |||||||||
| Address1: | 16111 PLUMMER ST # 117A | ||||||||
| Address2: | |||||||||
| City: | NORTH HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913432036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188917711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 226300000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Kinesiotherapist |
No ID Information.