Healthcare Provider Details

I. General information

NPI: 1215470281
Provider Name (Legal Business Name): SERENITY MEDICAL MASSAGE & BODYWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15315 1ST AVE NE
DUVALL WA
98019-6339
US

IV. Provider business mailing address

24121 NE 140TH ST
WOODINVILLE WA
98077-7281
US

V. Phone/Fax

Practice location:
  • Phone: 425-788-0505
  • Fax: 425-788-3340
Mailing address:
  • Phone: 425-788-0505
  • Fax: 425-788-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00010003
License Number StateWA

VIII. Authorized Official

Name: MS. JODY M BICKLE
Title or Position: OWNER
Credential: LMT
Phone: 253-232-6377