Provider Demographics
NPI:1134476070
Name:SERETIS, PAMELA SUZANNE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUZANNE
Last Name:SERETIS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 HARDING HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CARNEYS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08069
Mailing Address - Country:US
Mailing Address - Phone:865-299-9229
Mailing Address - Fax:
Practice Address - Street 1:291 HARDING HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:CARNEYS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08069
Practice Address - Country:US
Practice Address - Phone:865-299-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00762100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist