Provider Demographics
NPI:1780896258
Name:SERRANO, RAFAEL (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 W WINONA ST
Mailing Address - Street 2:UNIT 3A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2937
Mailing Address - Country:US
Mailing Address - Phone:773-983-8470
Mailing Address - Fax:
Practice Address - Street 1:1264 W WINONA ST
Practice Address - Street 2:UNIT 3A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2937
Practice Address - Country:US
Practice Address - Phone:773-983-8470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70011701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist