Provider Demographics
NPI:1588021034
Name:SEVERIN, KATY (LMT)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:SEVERIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13325 NE 41ST TER
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:FL
Mailing Address - Zip Code:32617-2419
Mailing Address - Country:US
Mailing Address - Phone:352-362-4331
Mailing Address - Fax:
Practice Address - Street 1:13325 NE 41ST TER
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:FL
Practice Address - Zip Code:32617-2419
Practice Address - Country:US
Practice Address - Phone:352-362-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA80330225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist