Provider Demographics
NPI:1235178039
Name:SEVERSON, RAMONA JAN (PT)
Entity Type:Individual
Prefix:MS
First Name:RAMONA
Middle Name:JAN
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 29TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2701
Mailing Address - Country:US
Mailing Address - Phone:360-293-9255
Mailing Address - Fax:
Practice Address - Street 1:1218 29TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2701
Practice Address - Country:US
Practice Address - Phone:360-293-9255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025208PT00005694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8661205Medicare PIN