Provider Demographics
NPI:1205193380
Name:SERRANO, DEANA LAREW (PT)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:LAREW
Last Name:SERRANO
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 1:6180 BROCKTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2259
Mailing Address - Country:US
Mailing Address - Phone:951-781-6653
Mailing Address - Fax:951-275-0149
Practice Address - Street 1:6180 BROCKTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2259
Practice Address - Country:US
Practice Address - Phone:951-781-6653
Practice Address - Fax:951-275-0149
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-0660225200000X
CA301493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant