Healthcare Provider Details

I. General information

NPI: 1114937695
Provider Name (Legal Business Name): SERENDIPITY INTEGRATED FITNESS AND REHAB STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 WASHINGTON ST SE
ALBUQUERQUE NM
87108-2735
US

IV. Provider business mailing address

314 WASHINGTON ST SE
ALBUQUERQUE NM
87108-2735
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-1230
  • Fax: 505-256-4831
Mailing address:
  • Phone: 505-823-1230
  • Fax: 505-256-4831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1242
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4329
License Number StateNM

VIII. Authorized Official

Name: MR. RICHARD GENE CASAUS
Title or Position: DIRECTOR REGISTERED AGENT LLC
Credential: LPT LMT
Phone: 505-823-1230