Provider Demographics
NPI:1285962746
Name:SEVIDAL, BENJAMIN C (LMT)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:C
Last Name:SEVIDAL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
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Mailing Address - Street 1:9422 KEEGANS WOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5954
Mailing Address - Country:US
Mailing Address - Phone:713-933-8266
Mailing Address - Fax:281-861-5990
Practice Address - Street 1:6600 HARWIN DR STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2233
Practice Address - Country:US
Practice Address - Phone:713-933-8266
Practice Address - Fax:281-861-5990
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-21
Last Update Date:2009-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT046676225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist