Provider Demographics
NPI:1205293610
Name:BEFFA, SERENA
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:BEFFA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GRAVOIS STA
Mailing Address - Street 2:
Mailing Address - City:HOUSE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:63051-4348
Mailing Address - Country:US
Mailing Address - Phone:636-375-3300
Mailing Address - Fax:636-375-3306
Practice Address - Street 1:20 GRAVOIS STA
Practice Address - Street 2:
Practice Address - City:HOUSE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:63051-4348
Practice Address - Country:US
Practice Address - Phone:636-375-3300
Practice Address - Fax:636-375-3306
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015044932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist