Provider Demographics
NPI:1124825575
Name:AMOS, SERENA TERESA (MASSAGE THERAPY)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:TERESA
Last Name:AMOS
Suffix:
Gender:
Credentials:MASSAGE THERAPY
Other - Prefix:
Other - First Name:SERENA
Other - Middle Name:TERESA
Other - Last Name:BASKERVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASSAGE THERAPY
Mailing Address - Street 1:2222 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2535
Mailing Address - Country:US
Mailing Address - Phone:208-513-9721
Mailing Address - Fax:
Practice Address - Street 1:3701 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4979
Practice Address - Country:US
Practice Address - Phone:425-259-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020812225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist