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General NPI Number Information
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NPI Number | 1275358889
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Entity Type | Organization
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Legal Business Name | SERENITY RX SPA, LLC
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 3096 BRICKHOUSE CT
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-6859
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Country | US
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Telephone | 757-278-6033
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Fax |
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Provider Business Mailing Address
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Address Line | 3096 BRICKHOUSE CT
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-6859
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Country | US
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Telephone | 757-278-6033
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MR. LARRY DEANGELO HARRIS
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Credential |
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Telephone | 757-348-6315
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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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