Provider Demographics
NPI:1578673000
Name:SERAFINO, GIA (PT)
Entity Type:Individual
Prefix:
First Name:GIA
Middle Name:
Last Name:SERAFINO
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 1:116 PLEASANT ST
Mailing Address - Street 2:SUITE 452
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-2752
Mailing Address - Country:US
Mailing Address - Phone:860-874-4194
Mailing Address - Fax:
Practice Address - Street 1:116 PLEASANT ST
Practice Address - Street 2:SUITE 452
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-2752
Practice Address - Country:US
Practice Address - Phone:860-874-4195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032692-1225100000X
MA15652225100000X
CT006890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006890OtherLICENSE #
MA15652OtherMA LICENSE NUMBER