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General NPI Number Information
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NPI Number | 1184086746
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Entity Type | Organization
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Legal Business Name | SERENITY MASSAGE BY RYLEE
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 2417 PACIFIC AVE SE
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City | OLYMPIA
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State | WA
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Zip | 98501-2052
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Country | US
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Telephone | 360-789-0654
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Fax |
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Provider Business Mailing Address
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Address Line | 7218 PRAIRIE RIDGE DR NE
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City | OLYMPIA
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State | WA
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Zip | 98516-2757
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE PRACTITIONER
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Name | MRS. RYLEE JEAN LANDWEHRLE
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Credential | LMP
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Telephone | 360-789-0654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00024002
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License Number State | WA
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