Provider Demographics
NPI:1053079509
Name:PROVEN PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PROVEN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRA
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT,OCS,FAAOMPT
Authorized Official - Phone:586-322-1940
Mailing Address - Street 1:145 E CADY ST
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1606
Mailing Address - Country:US
Mailing Address - Phone:248-773-7540
Mailing Address - Fax:248-907-1117
Practice Address - Street 1:145 E CADY ST
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1606
Practice Address - Country:US
Practice Address - Phone:248-773-7540
Practice Address - Fax:248-907-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy