Provider Demographics
NPI:1578698254
Name:SEROTA, RONNA
Entity Type:Individual
Prefix:
First Name:RONNA
Middle Name:
Last Name:SEROTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 LEHIGH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3880
Mailing Address - Country:US
Mailing Address - Phone:610-289-0114
Mailing Address - Fax:610-289-4282
Practice Address - Street 1:1501 LEHIGH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3880
Practice Address - Country:US
Practice Address - Phone:610-289-0114
Practice Address - Fax:610-289-4282
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-006121-L171W00000X
225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01782466Medicaid