Provider Demographics
NPI:1326315821
Name:SURREAL SERENITY MASSAGE THERAPY, LLC.
Entity Type:Organization
Organization Name:SURREAL SERENITY MASSAGE THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEREE
Authorized Official - Middle Name:T
Authorized Official - Last Name:SOPHAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:917-650-6857
Mailing Address - Street 1:519 BEACH 66TH STREET, SUITE 3
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1330
Mailing Address - Country:US
Mailing Address - Phone:917-650-6857
Mailing Address - Fax:
Practice Address - Street 1:519 BEACH 66TH ST STE 3
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1330
Practice Address - Country:US
Practice Address - Phone:917-650-6857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty