Provider Demographics
NPI:1497159917
Name:SERAFINO, CLINTON WAYNE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:WAYNE
Last Name:SERAFINO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 DICKERSON BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-2884
Mailing Address - Country:US
Mailing Address - Phone:704-283-6700
Mailing Address - Fax:704-283-6713
Practice Address - Street 1:9216 ARDREY KELL RD STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4954
Practice Address - Country:US
Practice Address - Phone:980-556-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11593225100000X
NC14730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist