Provider Demographics
NPI:1629674122
Name:SERRANO, REBECCA (PTA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WOODBERRY CT, WOLCOTT
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716
Mailing Address - Country:US
Mailing Address - Phone:203-695-9239
Mailing Address - Fax:774-430-6421
Practice Address - Street 1:22 WOODBERRY CT, WOLCOTT
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-0671
Practice Address - Country:US
Practice Address - Phone:203-695-9239
Practice Address - Fax:774-430-6421
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2108225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant