Provider Demographics
NPI:1396012696
Name:SIASOYCO, SEVERO BATION II (PT)
Entity Type:Individual
Prefix:MR
First Name:SEVERO
Middle Name:BATION
Last Name:SIASOYCO
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2489 LADOGA DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-9540
Mailing Address - Country:US
Mailing Address - Phone:863-617-3332
Mailing Address - Fax:
Practice Address - Street 1:2115 MORGAN WIELAND LN
Practice Address - Street 2:APT 202
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3181
Practice Address - Country:US
Practice Address - Phone:863-617-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP0024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist