| Organization Name: | SERC REHABILITATION PARTNERS LLC |
| NPI Number: | 1013384833 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEVIN JOHANNESON (VP REVENUE CYCLE OPERATIONS) |
| Mailing Address: | 501 S Madison St Ste L Webb City |
| State: | MO US |
| Postal Code: | 648702502 |
| Phone Number: | 4176732157 |
| Fax Number: | 4176732176 |
| NPI Enumeration Date: | 08/27/2015 |
| NPI Last Update Date: | 08/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |