Provider Demographics
NPI:1215402482
Name:SERENEBIRD MASSAGE LLC
Entity Type:Organization
Organization Name:SERENEBIRD MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:253-221-1590
Mailing Address - Street 1:1026 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-2800
Mailing Address - Country:US
Mailing Address - Phone:253-221-1590
Mailing Address - Fax:253-841-8526
Practice Address - Street 1:12515 MERIDIAN E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3436
Practice Address - Country:US
Practice Address - Phone:253-221-1590
Practice Address - Fax:253-841-8526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty