Provider Demographics
NPI:1184194003
Name:KNOT SO ZEN, LLC
Entity type:Organization
Organization Name:KNOT SO ZEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RENDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, MMP
Authorized Official - Phone:757-592-9102
Mailing Address - Street 1:780 PILOT HOUSE DR STE 100A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4411
Mailing Address - Country:US
Mailing Address - Phone:757-592-9102
Mailing Address - Fax:
Practice Address - Street 1:780 PILOT HOUSE DR STE 100A
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4411
Practice Address - Country:US
Practice Address - Phone:757-251-8207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty