Provider Demographics
NPI:1093057770
Name:SERRA PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:SERRA PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SERRA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MTC, CSCS
Authorized Official - Phone:401-289-2553
Mailing Address - Street 1:60 BAY SPRING AVE
Mailing Address - Street 2:A2
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1384
Mailing Address - Country:US
Mailing Address - Phone:401-289-2553
Mailing Address - Fax:
Practice Address - Street 1:60 BAY SPRING AVE
Practice Address - Street 2:A2
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1384
Practice Address - Country:US
Practice Address - Phone:401-289-2553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01462261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy