Provider Demographics
NPI:1912686544
Name:SEVINSKY, DANE MATTHEW
Entity Type:Individual
Prefix:
First Name:DANE
Middle Name:MATTHEW
Last Name:SEVINSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 N JONES ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-1923
Mailing Address - Country:US
Mailing Address - Phone:814-203-2312
Mailing Address - Fax:
Practice Address - Street 1:432 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-1135
Practice Address - Country:US
Practice Address - Phone:570-484-2417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer