Organization
SERC REHABILITATION PARTNERS, LLC
Active
Other names
SERC
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN JOHANNESON (MANAGER)
(423) 238-8923
Entity
Organization
Contact information
Practice address
17134 BEL RAY PL, BELTON, MO 64012-5331
(816) 226-4011
(816) 524-6115
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
225XE1200X
Ergonomics Occupational Therapist
—
—
225XH1200X
Hand Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KA2868
MEDICARE PTAN
KS
01
—
MA4370
MEDICARE PTAN
MO
Enumeration date
06/20/2012
Last updated
12/09/2014
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