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General NPI Number Information
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NPI Number | 1093057770
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Entity Type | Organization
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Legal Business Name | SERRA PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 03/20/2013
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Last Update Date | 07/15/2016
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Provider Practice Location Address
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Address Line | 60 BAY SPRING AVE A2
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City | BARRINGTON
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State | RI
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Zip | 02806-1384
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Country | US
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Telephone | 401-289-2553
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Fax |
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Provider Business Mailing Address
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Address Line | 60 BAY SPRING AVE A2
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City | BARRINGTON
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State | RI
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Zip | 02806-1384
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Country | US
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Telephone | 401-289-2553
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER/MEMBER
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Name | DR. KIMBERLY MARIE SERRA
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Credential | PT, DPT, MTC, CSCS
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Telephone | 401-289-2553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT01462
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License Number State | RI
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