MEDICARE: KENDRA SERENO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	12603	CO

General Provider Information

NPI Number	:	1073924320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA SERENO

Provider Business Mailing Address
First Line	:	7621 AUSTIN BLUFFS PKWY
Second Line	:	SUITE 200
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-2906
Country	:	US
Telephone Number	:	719-596-5000
Fax Number	:	719-596-0890

Provider Business Practice Location Address
First Line	:	7621 AUSTIN BLUFFS PKWY
Second Line	:	SUITE 200
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-2906
Country	:	US
Telephone Number	:	719-596-5000
Fax Number	:	719-596-0890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2014
Last Update Date	:	05/08/2014

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Directions to “ KENDRA SERENO ” Practice Location

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