Organization
SERC REHABILITATION PARTNERS LLC
Active
Other names
SERC - Lakewood Blvd
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN JOHANNESON (VP REVENE CYCLE OPERATIONS)
(423) 238-7217
Entity
Organization
Contact information
Practice address
827 NE LAKEWOOD BLVD, LEES SUMMIT, MO 64064-1366
(816) 533-6931
(816) 350-3925
Mailing address
6397 LEE HWY STE 300, CHATTANOOGA, TN 37421-2564
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA4370
MEDICARE PTAN
MO
Enumeration date
07/01/2014
Last updated
07/21/2022
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