Active NPI
Severiano Fernandez, PTA
- Physical Therapy Assistant
- Chicago, IL
National Provider Identifier
1699688036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 160.010110
- Practice address
- 200 E Randolph St Ste 5100
Chicago, IL 60601-6528 - Phone
- (630) 474-2759
- NPI assigned
- Sep 25, 2026
- Last updated
- Sep 25, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160.010110 | IL | Primary |
Addresses
Primary practice location
200 E Randolph St Ste 5100
Chicago, IL 60601-6528
Mailing address
3614 W George St Apt 2F
Chicago, IL 60618-7882
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1790294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790294400000",
"number": "1699688036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3614 W GEORGE ST APT 2F",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606187882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 E RANDOLPH ST STE 5100",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606016528",
"telephone_number": "630-474-2759"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERNANDEZ",
"first_name": "SEVERIANO",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-09-25",
"last_updated": "2026-09-25",
"certification_date": "2026-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "160.010110",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.