Provider Demographics
NPI:1215602065
Name:SOLE'RENITY SPA, INC.
Entity Type:Organization
Organization Name:SOLE'RENITY SPA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:PITMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-736-5054
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-0711
Mailing Address - Country:US
Mailing Address - Phone:940-736-5054
Mailing Address - Fax:580-622-6350
Practice Address - Street 1:1001 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-4818
Practice Address - Country:US
Practice Address - Phone:580-622-8128
Practice Address - Fax:580-622-6350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty