MEDICARE: SERENITY THERAPEUTIC MASSAGE SPA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1982370920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY THERAPEUTIC MASSAGE SPA, LLC

Provider Business Mailing Address
First Line	:	217 WOODLANDS W
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-3380
Country	:	US
Telephone Number	:	803-287-0064
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001 SAINT ANDREWS RD STE B8
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-1137
Country	:	US
Telephone Number	:	803-401-5323
Fax Number	:

Authorized Official
Title or Position	:	OWNER / THERAPIST
Name	:	ANGELA O RALEY
Credential	:	MASSAGE THERAPIST
Telephone Number	:	803-401-5323

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	08/19/2021

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