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General NPI Number Information
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NPI Number | 1699275396
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Entity Type | Individual
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Provider Name | KRISTEN MARIE SEROKA PT
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Gender | Female
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Dates
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Enumeration Date | 02/19/2018
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Last Update Date | 07/31/2019
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Provider Practice Location Address
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Address Line | 20329 N 59TH AVE STE A2
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City | GLENDALE
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State | AZ
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Zip | 85308-6854
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Country | US
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Telephone | 623-215-4161
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Fax | 623-201-8589
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Provider Business Mailing Address
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Address Line | 20329 N 59TH AVE STE A2
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City | GLENDALE
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State | AZ
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Zip | 85308-6854
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Country | US
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Telephone | 623-215-4161
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Fax | 623-201-8589
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 13375
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT016495
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License Number State | OH
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