Provider Demographics
NPI:1376592774
Name:SEVERT, BOBBI A (ATC)
Entity Type:Individual
Prefix:MRS
First Name:BOBBI
Middle Name:A
Last Name:SEVERT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8258 HICKORY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-4036
Mailing Address - Country:US
Mailing Address - Phone:931-738-7915
Mailing Address - Fax:
Practice Address - Street 1:1120 SAMS ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-4006
Practice Address - Country:US
Practice Address - Phone:931-528-7312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer