1023249455 NPI number — MRS. KRISTEN CATHLEEN SEVERSON DPT

Table of content: MRS. KRISTEN CATHLEEN SEVERSON DPT (NPI 1023249455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023249455 NPI number — MRS. KRISTEN CATHLEEN SEVERSON DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEVERSON
Provider First Name:
KRISTEN
Provider Middle Name:
CATHLEEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DANIEL
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
CATHLEEN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023249455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3321 E QUEEN CREEK RD
Provider Second Line Business Mailing Address:
STE 106
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85297-8530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-550-9100
Provider Business Mailing Address Fax Number:
480-550-9100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3321 E QUEEN CREEK RD
Provider Second Line Business Practice Location Address:
STE 106
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85297-8530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-550-9100
Provider Business Practice Location Address Fax Number:
480-550-9100
Provider Enumeration Date:
08/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  8614 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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