Individual
DARYL SEVILLENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2810 RULEME ST, EUSTIS, FL 32726-6527
(352) 483-5037
Mailing address
2800 RULEME ST APT D48, EUSTIS, FL 32726-6543
(362) 391-7564
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT23886
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GEA5045576900
INDEPENDECE BLUE CROSS
FL
Enumeration date
11/25/2008
Last updated
11/25/2008
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