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General NPI Number Information
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NPI Number | 1598150005
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Entity Type | Organization
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Legal Business Name | SERENITY MASSAGE AND BODYWORKS
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 04/01/2015
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Provider Practice Location Address
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Address Line | 20811 DAWN DR SUITE 800
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City | LAGO VISTA
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State | TX
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Zip | 78645-5213
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Country | US
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Telephone | 512-969-1670
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Fax |
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Provider Business Mailing Address
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Address Line | 307 SOUTHWIND RD
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City | LAGO VISTA
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State | TX
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Zip | 78645-8612
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Country | US
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Telephone | 512-969-1670
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEPHEN M THOMPSON
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Credential | LMT
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Telephone | 512-969-1670
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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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