Healthcare Provider Details

I. General information

NPI: 1093920639
Provider Name (Legal Business Name): SERC OF HARRISONVILLE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 WESTCHESTER AVENUE
HARRISONVILLE MO
64701
US

IV. Provider business mailing address

815 WESTCHESTER AVENUE
HARRISONVILLE MO
64701
US

V. Phone/Fax

Practice location:
  • Phone: 816-380-3344
  • Fax: 816-380-3044
Mailing address:
  • Phone: 816-380-3344
  • Fax: 816-380-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateMO

VIII. Authorized Official

Name: SHERRY A PURVIS
Title or Position: OWNER, MANAGER, PHYSICAL THERAPIST
Credential: PT
Phone: 816-380-3344