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General NPI Number Information
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NPI Number | 1114610193
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Entity Type | Individual
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Provider Name | BRIAN JEFFREY SERBER PTA
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Gender | Male
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Dates
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Enumeration Date | 05/26/2023
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 6200 XERXES AVE S
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City | EDINA
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State | MN
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Zip | 55423-1033
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Country | US
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Telephone | 952-925-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 8987 UNDERWOOD LN N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-6730
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Country | US
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Telephone | 612-805-4894
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A2844
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License Number State | MN
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