Provider Demographics
NPI:1306100391
Name:SERENE REJUVENATION MASSAGE THERAPY, L.L.C.
Entity type:Organization
Organization Name:SERENE REJUVENATION MASSAGE THERAPY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:253-262-3118
Mailing Address - Street 1:21715 103RD AVENUE CT E
Mailing Address - Street 2:SUITE # D-401
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-8152
Mailing Address - Country:US
Mailing Address - Phone:253-262-3118
Mailing Address - Fax:253-262-3133
Practice Address - Street 1:21715 103RD AVENUE CT E
Practice Address - Street 2:SUITE # D-401
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8152
Practice Address - Country:US
Practice Address - Phone:253-262-3118
Practice Address - Fax:253-262-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty