Provider Demographics
NPI:1023331527
Name:SERRA, CRAIG J (DPT, OCS, FAAOMPT)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:J
Last Name:SERRA
Suffix:
Gender:M
Credentials:DPT, OCS, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 E CADY ST
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1606
Mailing Address - Country:US
Mailing Address - Phone:248-773-7540
Mailing Address - Fax:248-907-1117
Practice Address - Street 1:145 E CADY ST
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1606
Practice Address - Country:US
Practice Address - Phone:248-773-7540
Practice Address - Fax:248-907-1117
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015106225100000X, 225100000X
KY005767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist