Healthcare Provider Details

I. General information

NPI: 1548307580
Provider Name (Legal Business Name): DENA SERATT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 SUMMIT STREET
DONIPHAN MO
63935
US

IV. Provider business mailing address

615 COUNTY ROAD 355
HARVIELL MO
63945-9113
US

V. Phone/Fax

Practice location:
  • Phone: 573-996-3523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number103003
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number103003
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: