Provider Demographics
NPI:1619485190
Name:SERENDIPITY THERAPEUTIC MASSAGE AND BODYWORK, INC.
Entity Type:Organization
Organization Name:SERENDIPITY THERAPEUTIC MASSAGE AND BODYWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIAANN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HAYES-HURST
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, ACUPUNCTURE PHY
Authorized Official - Phone:772-521-3638
Mailing Address - Street 1:1101 DRIFTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-3317
Mailing Address - Country:US
Mailing Address - Phone:772-521-3638
Mailing Address - Fax:
Practice Address - Street 1:800 VIRGINIA AVE STE 57
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-5892
Practice Address - Country:US
Practice Address - Phone:772-521-3638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3906261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care