Provider Demographics
NPI:1346823382
Name:SERIALE, KENNEDY PAIGE (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:PAIGE
Last Name:SERIALE
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:MRS
Other - First Name:KENNEDY
Other - Middle Name:PAIGE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAT, LAT, ATC
Mailing Address - Street 1:13501 HOLLYPARK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-2902
Mailing Address - Country:US
Mailing Address - Phone:832-386-3782
Mailing Address - Fax:
Practice Address - Street 1:353 N CASTLEGORY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-1739
Practice Address - Country:US
Practice Address - Phone:713-726-6107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT95092255A2300X
20000542302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer