Healthcare Provider Details

I. General information

NPI: 1972719177
Provider Name (Legal Business Name): SERC OF LIBERTY, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 NE 96TH ST SUITE A
LIBERTY MO
64068-1348
US

IV. Provider business mailing address

1512 NE 96TH ST SUITE A
LIBERTY MO
64068-1348
US

V. Phone/Fax

Practice location:
  • Phone: 816-792-0775
  • Fax: 816-792-0776
Mailing address:
  • Phone: 816-792-0775
  • Fax: 816-792-0776

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: CHAD E HELMER
Title or Position: OWNER, MANAGER, PHYSICAL THERAPIST
Credential: PT
Phone: 816-792-0775