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General NPI Number Information
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NPI Number | 1659169894
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Entity Type | Organization
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Legal Business Name | RADIANCE MASSAGE AND BODYWORK
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 550 BALMORAL CIR N STE 203
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City | JACKSONVILLE
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State | FL
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Zip | 32218-5577
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Country | US
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Telephone | 561-951-0914
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Fax |
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Provider Business Mailing Address
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Address Line | 11514 HARLAN DR
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City | JACKSONVILLE
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State | FL
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Zip | 32218-4052
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Country | US
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Telephone | 561-951-0914
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Fax | 561-951-0914
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | PAULA MARCELA SERRANO
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Credential | LMT
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Telephone | 561-951-0914
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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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