Provider Demographics
NPI:1134403827
Name:SERRANO, NIKKI (PT)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3178 SUMMIT SQUARE DR D8
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2880
Mailing Address - Country:US
Mailing Address - Phone:516-342-0907
Mailing Address - Fax:703-319-2078
Practice Address - Street 1:3178 SUMMIT SQUARE DR APT D8
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-2880
Practice Address - Country:US
Practice Address - Phone:516-342-0907
Practice Address - Fax:703-319-2078
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028042174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist