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General NPI Number Information
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NPI Number | 1215402482
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Entity Type | Organization
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Legal Business Name | SERENEBIRD MASSAGE LLC
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Dates
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Enumeration Date | 10/03/2018
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Last Update Date | 10/03/2018
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Provider Practice Location Address
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Address Line | 12515 MERIDIAN E
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City | PUYALLUP
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State | WA
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Zip | 98373-3436
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Country | US
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Telephone | 253-221-1590
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Fax | 253-841-8526
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Provider Business Mailing Address
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Address Line | 1026 E 49TH ST
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City | TACOMA
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State | WA
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Zip | 98404-2800
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Country | US
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Telephone | 253-221-1590
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Fax | 253-841-8526
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | KIA M KING
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Credential | LMT
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Telephone | 253-221-1590
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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 |
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License Number State |
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