Healthcare Provider Details

I. General information

NPI: 1134384555
Provider Name (Legal Business Name): SERENITY SPA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 MARKET ST
TACOMA WA
98402-3712
US

IV. Provider business mailing address

706 MARKET ST
TACOMA WA
98402-3712
US

V. Phone/Fax

Practice location:
  • Phone: 253-473-7830
  • Fax: 253-267-1607
Mailing address:
  • Phone: 253-473-7830
  • Fax: 253-267-1607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEGAN DOUGLAS
Title or Position: PRESIDENT
Credential: LMT
Phone: 253-473-7830