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General NPI Number Information
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NPI Number | 1619485190
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Entity Type | Organization
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Legal Business Name | SERENDIPITY THERAPEUTIC MASSAGE AND BODYWORK, INC.
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 01/18/2018
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Provider Practice Location Address
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Address Line | 800 VIRGINIA AVE STE 57
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City | FORT PIERCE
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State | FL
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Zip | 34982-5892
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Country | US
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Telephone | 772-521-3638
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 DRIFTWOOD LN
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City | FORT PIERCE
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State | FL
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Zip | 34982-3317
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Country | US
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Telephone | 772-521-3638
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, OWNER
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Name | CYNTHIAANN LEE HAYES-HURST
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Credential | DOM, ACUPUNCTURE PHY
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Telephone | 772-521-3638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | AP3906
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License Number State | FL
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