Provider Demographics
NPI:1356906267
Name:SERMENO, FRANCES RAQUEL (PTA)
Entity type:Individual
Prefix:
First Name:FRANCES
Middle Name:RAQUEL
Last Name:SERMENO
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 1:4302 E VINEYARD RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-5240
Mailing Address - Country:US
Mailing Address - Phone:480-369-0993
Mailing Address - Fax:
Practice Address - Street 1:4302 E VINEYARD RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-5240
Practice Address - Country:US
Practice Address - Phone:480-369-0993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ012646225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant