Provider Demographics
NPI:1982370920
Name:SERENITY THERAPEUTIC MASSAGE SPA, LLC
Entity Type:Organization
Organization Name:SERENITY THERAPEUTIC MASSAGE SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:O
Authorized Official - Last Name:RALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:803-401-5323
Mailing Address - Street 1:217 WOODLANDS W
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-3380
Mailing Address - Country:US
Mailing Address - Phone:803-287-0064
Mailing Address - Fax:
Practice Address - Street 1:7001 SAINT ANDREWS RD STE B8
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1137
Practice Address - Country:US
Practice Address - Phone:803-401-5323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty