Provider Demographics
NPI:1083371223
Name:SERNA BETANCOURT, NATALIA (PT)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:SERNA BETANCOURT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 SW 3RD AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-4208
Mailing Address - Country:US
Mailing Address - Phone:760-798-5440
Mailing Address - Fax:
Practice Address - Street 1:1228 SW 3RD AVE APT 303
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-4208
Practice Address - Country:US
Practice Address - Phone:760-798-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL38122225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist