Provider Demographics
NPI:1386932325
Name:SEREDA, ARKADIUSZ GRZEGORZ (PT)
Entity type:Individual
Prefix:MR
First Name:ARKADIUSZ
Middle Name:GRZEGORZ
Last Name:SEREDA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:AREK
Other - Middle Name:
Other - Last Name:SEREDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1412 BLACK RIVER BLVD N
Mailing Address - Street 2:APT.8
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-3629
Mailing Address - Country:US
Mailing Address - Phone:315-339-9719
Mailing Address - Fax:315-339-9719
Practice Address - Street 1:5635 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NY
Practice Address - Zip Code:13478-3705
Practice Address - Country:US
Practice Address - Phone:315-363-9253
Practice Address - Fax:315-363-9348
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014997-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist