Provider Demographics
NPI:1982741500
Name:SERRANO, JOSEPH L (RPT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:L
Last Name:SERRANO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4157 EAGLE ROCK BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-4492
Mailing Address - Country:US
Mailing Address - Phone:323-982-1566
Mailing Address - Fax:323-982-1680
Practice Address - Street 1:4157 EAGLE ROCK BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-4492
Practice Address - Country:US
Practice Address - Phone:323-982-1566
Practice Address - Fax:323-982-1680
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist