Provider Demographics
NPI:1114000445
Name:SEIVERT PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:SEIVERT PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SEIVERT
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT GDMT
Authorized Official - Phone:530-272-7306
Mailing Address - Street 1:1020 MCCOURTNEY RD # D
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-7400
Mailing Address - Country:US
Mailing Address - Phone:530-272-7306
Mailing Address - Fax:530-272-7316
Practice Address - Street 1:1020 MCCOURTNEY RD # D
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-7400
Practice Address - Country:US
Practice Address - Phone:530-272-7306
Practice Address - Fax:530-272-7316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ08443ZOtherBLUE SHIELD
CAZZZ08443ZOtherBLUE SHIELD