Provider Demographics
NPI:1215154380
Name:RICHARD, SERENA CHRISTIE (PTA)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:CHRISTIE
Last Name:RICHARD
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 1:1042 ELBERTA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77051-1724
Mailing Address - Country:US
Mailing Address - Phone:713-876-5689
Mailing Address - Fax:
Practice Address - Street 1:1042 ELBERTA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77051-1724
Practice Address - Country:US
Practice Address - Phone:713-876-5689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2020228225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant