Provider Demographics
NPI:1255844874
Name:STROM, RAQUEL SERRA (PT,DPT, ATC)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:SERRA
Last Name:STROM
Suffix:
Gender:F
Credentials:PT,DPT, ATC
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:
Other - Last Name:SERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 BROADWAY
Mailing Address - Street 2:ATTN: INPATIENT PHYSICAL THERAPY DEPARTMENT
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5730
Mailing Address - Country:US
Mailing Address - Phone:510-752-1000
Mailing Address - Fax:
Practice Address - Street 1:3600 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5730
Practice Address - Country:US
Practice Address - Phone:510-752-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0012793225100000X
CAPT294169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist