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General NPI Number Information
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NPI Number | 1457734717
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Entity Type | Organization
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Legal Business Name | SERC REHABILITATION PARTNERS LLC
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Dates
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Enumeration Date | 07/06/2015
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Last Update Date | 07/06/2015
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Provider Practice Location Address
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Address Line | 108 W MAPLE AVE
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City | INDEPENDENCE
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State | MO
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Zip | 64050-2814
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Country | US
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Telephone | 816-254-4548
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Fax | 816-254-4605
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Provider Business Mailing Address
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Address Line | 8823 PRODUCTION LN
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City | OOLTEWAH
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State | TN
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Zip | 37363-6511
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Country | US
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Telephone | 423-238-7217
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Fax | 423-238-3473
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Authorized Official
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Title or Position | VP REVENUE CYCLE OPERATIONS
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Name | KEVIN JOHANNESON
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Credential |
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Telephone | 423-238-7217
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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 |
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License Number State |
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