Provider Demographics
NPI:1073293031
Name:TYSON, SEREN ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:SEREN
Middle Name:ELIZABETH
Last Name:TYSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SEREN
Other - Middle Name:ELIZABETH
Other - Last Name:WAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:28366 APEX AVE
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-4244
Mailing Address - Country:US
Mailing Address - Phone:816-345-0914
Mailing Address - Fax:
Practice Address - Street 1:28366 APEX AVE
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-4244
Practice Address - Country:US
Practice Address - Phone:816-345-0914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006017308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist