Healthcare Provider Details

I. General information

NPI: 1154254738
Provider Name (Legal Business Name): NATHANIEL S SERRURIER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S FRONTAGE RD W
VAIL CO
81657-5038
US

IV. Provider business mailing address

837 NW ALBEMARLE TER
PORTLAND OR
97210-3116
US

V. Phone/Fax

Practice location:
  • Phone: 970-476-1225
  • Fax:
Mailing address:
  • Phone: 503-894-0479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0021343
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: