Provider Demographics
NPI:1366585721
Name:SERRANO, MICHAEL (CMT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8214
Mailing Address - Country:US
Mailing Address - Phone:570-387-6675
Mailing Address - Fax:
Practice Address - Street 1:2201 5TH STREET HOLLOW RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-7757
Practice Address - Country:US
Practice Address - Phone:570-594-4299
Practice Address - Fax:570-387-1933
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist