Healthcare Provider Details

I. General information

NPI: 1588627343
Provider Name (Legal Business Name): WILLIAM WAYNE SERENA JR. PT, MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7270 GADSDEN HWY # 104-108
TRUSSVILLE AL
35173-2640
US

IV. Provider business mailing address

7270 GADSDEN HWY # 104-108
TRUSSVILLE AL
35173-2640
US

V. Phone/Fax

Practice location:
  • Phone: 659-444-1193
  • Fax: 205-895-6639
Mailing address:
  • Phone: 659-444-1193
  • Fax: 205-895-6639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT013951L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH8403
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: