Provider Demographics
NPI:1215470281
Name:SERENITY MEDICAL MASSAGE & BODYWORK LLC
Entity type:Organization
Organization Name:SERENITY MEDICAL MASSAGE & BODYWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:253-232-6377
Mailing Address - Street 1:24121 NE 140TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077-7281
Mailing Address - Country:US
Mailing Address - Phone:425-788-0505
Mailing Address - Fax:425-788-3340
Practice Address - Street 1:15315 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-6339
Practice Address - Country:US
Practice Address - Phone:425-788-0505
Practice Address - Fax:425-788-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010003174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty