Individual
STEPHEN KYLE SEVERE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
209 W 300 N, LOGAN, UT 84321-3809
(435) 716-8553
Mailing address
209 W 300 N, LOGAN, UT 84321-3809
(435) 716-8553
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7702617-2401
UT
225100000X
Physical Therapist
PT-4631
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7702617-2401
UTAH PT LICENSE
UT
01
—
PT-4631
IDAHO PT LICENSE
ID
Enumeration date
03/23/2017
Last updated
03/23/2017
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