Provider Demographics
NPI:1750300463
Name:SERODIO, KATIE L (DPT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:L
Last Name:SERODIO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 NEWTON RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2424
Mailing Address - Country:US
Mailing Address - Phone:978-388-7272
Mailing Address - Fax:978-388-7373
Practice Address - Street 1:920 LAFAYETTE RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SEABROOK
Practice Address - State:NH
Practice Address - Zip Code:03874-4216
Practice Address - Country:US
Practice Address - Phone:603-474-2259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2962225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
495008OtherTUFTS HEALTH PLAN INDIV #
NH084007528NH03OtherANTHEM INDIV #
495008OtherTUFTS HEALTH PLAN INDIV #
495008OtherTUFTS HEALTH PLAN INDIV #