Provider Demographics
NPI:1932354537
Name:SERENITY HEALTH SPA, LLC
Entity Type:Organization
Organization Name:SERENITY HEALTH SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-678-7100
Mailing Address - Street 1:2295 S HIAWASSEE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8746
Mailing Address - Country:US
Mailing Address - Phone:407-678-7100
Mailing Address - Fax:407-678-7200
Practice Address - Street 1:2295 S HIAWASSEE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8746
Practice Address - Country:US
Practice Address - Phone:407-678-7100
Practice Address - Fax:407-678-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL08000106026225100000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty