Provider Demographics
NPI:1851694970
Name:SERMAN, REGAN ELIZABETH (PTA)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:ELIZABETH
Last Name:SERMAN
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 1:4410 TERRACE VIEW RD
Mailing Address - Street 2:APT. L
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-4673
Mailing Address - Country:US
Mailing Address - Phone:865-603-4610
Mailing Address - Fax:
Practice Address - Street 1:5822 LYONS VIEW PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6471
Practice Address - Country:US
Practice Address - Phone:865-588-6358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000004831225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant