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General NPI Number Information
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NPI Number | 1851694970
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Entity Type | Individual
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Provider Name | REGAN ELIZABETH SERMAN PTA
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Gender | Female
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Dates
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Enumeration Date | 12/10/2010
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Last Update Date | 12/10/2010
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Provider Practice Location Address
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Address Line | 5822 LYONS VIEW PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37919-6471
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Country | US
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Telephone | 865-588-6358
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Fax |
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Provider Business Mailing Address
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Address Line | 4410 TERRACE VIEW RD APT. L
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City | LOUISVILLE
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State | TN
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Zip | 37777-4673
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Country | US
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Telephone | 865-603-4610
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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 | PTA0000004831
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License Number State | TN
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