Provider Demographics
NPI:1790858199
Name:SERRA, KIMBERLY M (PT, DPT, MTC, CSCS)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:M
Last Name:SERRA
Suffix:
Gender:F
Credentials:PT, DPT, MTC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BAY SPRING AVE
Mailing Address - Street 2:UNIT A2
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1385
Mailing Address - Country:US
Mailing Address - Phone:401-289-2553
Mailing Address - Fax:401-289-2883
Practice Address - Street 1:60 BAY SPRING AVE
Practice Address - Street 2:A2
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1384
Practice Address - Country:US
Practice Address - Phone:401-289-2553
Practice Address - Fax:401-289-2883
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0070084501Medicare UPIN