Provider Demographics
NPI:1326156589
Name:SEVERANCE, NEAL JAY (RKT)
Entity Type:Individual
Prefix:MR
First Name:NEAL
Middle Name:JAY
Last Name:SEVERANCE
Suffix:
Gender:M
Credentials:RKT
Other - Prefix:
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Mailing Address - Street 1:5275 MILDRED ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-4534
Mailing Address - Country:US
Mailing Address - Phone:805-581-6159
Mailing Address - Fax:805-306-5934
Practice Address - Street 1:16111 PLUMMER ST # 117A
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-2036
Practice Address - Country:US
Practice Address - Phone:818-891-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist