Provider Demographics
NPI:1447594197
Name:SIVERO, CLARE MARIE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CLARE
Middle Name:MARIE
Last Name:SIVERO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:CLARE
Other - Middle Name:MARIE
Other - Last Name:NAGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:30252 TOMAS STE 100
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2181
Mailing Address - Country:US
Mailing Address - Phone:949-459-1658
Mailing Address - Fax:949-459-1667
Practice Address - Street 1:30252 TOMAS STE 100
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2181
Practice Address - Country:US
Practice Address - Phone:949-459-1658
Practice Address - Fax:949-459-1667
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT39201225100000X, 261QP2000X
225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist