Provider Demographics
NPI:1417661018
Name:SO SERENE MASSAGE DAY SPA
Entity Type:Organization
Organization Name:SO SERENE MASSAGE DAY SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AIVIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:352-514-9494
Mailing Address - Street 1:58 N CHARLES RICHARD BEALL BLVD STE I
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2212
Mailing Address - Country:US
Mailing Address - Phone:352-514-9494
Mailing Address - Fax:
Practice Address - Street 1:58 N CHARLES RICHARD BEALL BLVD STE I
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2212
Practice Address - Country:US
Practice Address - Phone:352-514-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty