Provider Demographics
NPI:1114937695
Name:SERENDIPITY INTEGRATED FITNESS AND REHAB STUDIO LLC
Entity Type:Organization
Organization Name:SERENDIPITY INTEGRATED FITNESS AND REHAB STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REGISTERED AGENT LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:CASAUS
Authorized Official - Suffix:
Authorized Official - Credentials:LPT LMT
Authorized Official - Phone:505-823-1230
Mailing Address - Street 1:314 WASHINGTON ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2735
Mailing Address - Country:US
Mailing Address - Phone:505-823-1230
Mailing Address - Fax:505-256-4831
Practice Address - Street 1:314 WASHINGTON ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2735
Practice Address - Country:US
Practice Address - Phone:505-823-1230
Practice Address - Fax:505-256-4831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1242225100000X
NM4329225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty