Healthcare Provider Details

I. General information

NPI: 1700218872
Provider Name (Legal Business Name): SERENITY THERAPIES/H3O AQUATICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 ROBERT ROSE DR
MURFREESBORO TN
37129-6373
US

IV. Provider business mailing address

PO BOX 1893
GALLATIN TN
37066-1893
US

V. Phone/Fax

Practice location:
  • Phone: 615-889-4413
  • Fax: 615-841-4829
Mailing address:
  • Phone: 615-889-4413
  • Fax: 615-841-4829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateTN

VIII. Authorized Official

Name: CHRISTA SIMPSON
Title or Position: CEO
Credential: MED
Phone: 615-594-0064