Provider Demographics
NPI:1083968911
Name:HEALING SERENITY THERAPEUTIC MASSAGE, LLC
Entity Type:Organization
Organization Name:HEALING SERENITY THERAPEUTIC MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALONSSO
Authorized Official - Middle Name:R
Authorized Official - Last Name:GAYTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-943-9545
Mailing Address - Street 1:5806 119TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-3749
Mailing Address - Country:US
Mailing Address - Phone:425-943-9545
Mailing Address - Fax:425-943-9546
Practice Address - Street 1:5806 119TH AVE SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-3749
Practice Address - Country:US
Practice Address - Phone:425-943-9545
Practice Address - Fax:425-943-9546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty