Provider Demographics
NPI:1639112824
Name:SERINA, RAYMOND VELEZ (PT)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:VELEZ
Last Name:SERINA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LAZY ACRES ROAD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763
Mailing Address - Country:US
Mailing Address - Phone:229-434-4608
Mailing Address - Fax:
Practice Address - Street 1:2336 DAWSON RD
Practice Address - Street 2:SUITE 1100
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2442
Practice Address - Country:US
Practice Address - Phone:229-312-8700
Practice Address - Fax:706-256-0830
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist