Provider Demographics
NPI:1639391352
Name:ZEA, SERENA MARIE (PT, CWS)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:MARIE
Last Name:ZEA
Suffix:
Gender:F
Credentials:PT, CWS
Other - Prefix:
Other - First Name:SERENA
Other - Middle Name:MARIE
Other - Last Name:SERENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:416 ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-2952
Mailing Address - Country:US
Mailing Address - Phone:843-538-2055
Mailing Address - Fax:
Practice Address - Street 1:416 ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2952
Practice Address - Country:US
Practice Address - Phone:843-538-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00475110OtherMEDICARE RAILROAD
VA015207T88Medicare PIN