Provider Demographics
NPI:1043042955
Name:SERLETIC, BRILEY K (DPT)
Entity type:Individual
Prefix:
First Name:BRILEY
Middle Name:K
Last Name:SERLETIC
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SE 4TH STREET
Mailing Address - Street 2:SUITE 150
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1350
Mailing Address - Country:US
Mailing Address - Phone:812-461-6716
Mailing Address - Fax:812-402-1250
Practice Address - Street 1:201 SE 4TH STREET
Practice Address - Street 2:SUITE 150
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1350
Practice Address - Country:US
Practice Address - Phone:812-461-6716
Practice Address - Fax:812-402-1250
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05015668A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist