Provider Demographics
NPI:1245383322
Name:SEVERINO, LANAIA ANN (PT)
Entity Type:Individual
Prefix:
First Name:LANAIA
Middle Name:ANN
Last Name:SEVERINO
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 1:6415 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4121
Mailing Address - Country:US
Mailing Address - Phone:509-327-4867
Mailing Address - Fax:
Practice Address - Street 1:6415 N MONROE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4121
Practice Address - Country:US
Practice Address - Phone:509-327-4867
Practice Address - Fax:509-327-0542
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8481756Medicaid
WAGAB8867421Medicare PIN
WA8481756Medicaid