Provider Demographics
NPI:1629551288
Name:SERRUTO, VIRGINIA (PT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:SERRUTO
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 1:1235 EAST BLVD STE E
Mailing Address - Street 2:#801
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5876
Mailing Address - Country:US
Mailing Address - Phone:914-498-2621
Mailing Address - Fax:
Practice Address - Street 1:1328 ORDERMORE AVE UNIT 4
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6136
Practice Address - Country:US
Practice Address - Phone:914-498-2621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041694-1225100000X
NCP19917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist