Provider Demographics
NPI:1992028104
Name:SERENITY REHAB & WELLNESS CENTER
Entity type:Organization
Organization Name:SERENITY REHAB & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST AND OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRVERA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-292-0011
Mailing Address - Street 1:3795 E NORTH ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6200
Mailing Address - Country:US
Mailing Address - Phone:864-292-0011
Mailing Address - Fax:264-292-0303
Practice Address - Street 1:3795 E NORTH ST
Practice Address - Street 2:SUITE 14
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6200
Practice Address - Country:US
Practice Address - Phone:864-292-0011
Practice Address - Fax:864-292-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty