Provider Demographics
NPI:1730199738
Name:SEIVERT, JOHN CHARLES (MS PT GDMT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHARLES
Last Name:SEIVERT
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Gender:M
Credentials:MS PT GDMT
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Mailing Address - Street 1:1020 MCCOURTNEY RD
Mailing Address - Street 2:D
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-7400
Mailing Address - Country:US
Mailing Address - Phone:530-272-7306
Mailing Address - Fax:530-272-7316
Practice Address - Street 1:1020 MCCOURTNEY RD
Practice Address - Street 2:D SEIVERT PHYSICAL THERAPY PC
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-7400
Practice Address - Country:US
Practice Address - Phone:530-272-7306
Practice Address - Fax:530-272-7316
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAOPT13037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ08443ZOtherBLUE SHIELD
CAZZZ08443ZOtherBLUE SHIELD