Provider Demographics
NPI:1497738579
Name:SEVILLE, PURISSA A (PT)
Entity Type:Individual
Prefix:MS
First Name:PURISSA
Middle Name:A
Last Name:SEVILLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:PURISSA
Other - Middle Name:A
Other - Last Name:SEVILLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:233 GARDEN PL
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-2217
Mailing Address - Country:US
Mailing Address - Phone:201-893-1995
Mailing Address - Fax:201-483-6527
Practice Address - Street 1:233 GARDEN PL
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-2217
Practice Address - Country:US
Practice Address - Phone:201-893-1995
Practice Address - Fax:201-483-6527
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA008403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist