Provider Demographics
NPI:1578043204
Name:SERPAS, JODI (DPT)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:SERPAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:LEIGH
Other - Last Name:ALBRITTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 S FARMERVILLE ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5941
Mailing Address - Country:US
Mailing Address - Phone:318-251-6103
Mailing Address - Fax:318-251-6116
Practice Address - Street 1:1200 S FARMERVILLE ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5941
Practice Address - Country:US
Practice Address - Phone:318-251-6103
Practice Address - Fax:318-251-6116
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09118R225100000X
ME09118R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist