Provider Demographics
NPI:1700167343
Name:SERSLAND, KERI KAY (PTA)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:KAY
Last Name:SERSLAND
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:PO BOX 461
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:IA
Mailing Address - Zip Code:50201-0461
Mailing Address - Country:US
Mailing Address - Phone:515-382-3366
Mailing Address - Fax:515-382-1576
Practice Address - Street 1:270 W 1ST ST
Practice Address - Street 2:SUITE H
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-2145
Practice Address - Country:US
Practice Address - Phone:515-986-9667
Practice Address - Fax:515-986-9642
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001570225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant