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General NPI Number Information
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NPI Number | 1497107197
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Entity Type | Organization
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Legal Business Name | ELM AND SERENITY LLC
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Dates
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Enumeration Date | 07/06/2016
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Last Update Date | 12/16/2022
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Provider Practice Location Address
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Address Line | 1312 VINCENT PL FL 2
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City | MC LEAN
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State | VA
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Zip | 22101-3676
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Country | US
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Telephone | 703-599-8031
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Fax |
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Provider Business Mailing Address
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Address Line | 1312 VINCENT PL FL 2
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City | MC LEAN
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State | VA
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Zip | 22101-3676
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Country | US
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Telephone | 703-599-8031
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IRIS MORRELL
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Credential | LMT
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Telephone | 703-599-8031
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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 | 0019005166
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License Number State | VA
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