Healthcare Provider Details

I. General information

NPI: 1811602972
Provider Name (Legal Business Name): SERENA ERENBURG DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 GASKINS RD
RICHMOND VA
23233-1414
US

IV. Provider business mailing address

2419 ISLANDVIEW DR
HENRICO VA
23233-2530
US

V. Phone/Fax

Practice location:
  • Phone: 804-747-0003
  • Fax:
Mailing address:
  • Phone: 804-877-6045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305213267
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: