Provider Demographics
NPI:1073062022
Name:SERENITY THERAPEUTIC MASSAGE
Entity Type:Organization
Organization Name:SERENITY THERAPEUTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IOANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:717-466-9102
Mailing Address - Street 1:912 W MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-9202
Mailing Address - Country:US
Mailing Address - Phone:717-466-9102
Mailing Address - Fax:717-556-8818
Practice Address - Street 1:912 W MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-9202
Practice Address - Country:US
Practice Address - Phone:717-466-9102
Practice Address - Fax:717-556-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG004082225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty