Healthcare Provider Details

I. General information

NPI: 1619785359
Provider Name (Legal Business Name): MIND TO BODY HEALING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 E INDIAN SCHOOL RD STE 120
PHOENIX AZ
85016-6873
US

IV. Provider business mailing address

3104 E INDIAN SCHOOL RD STE 120
PHOENIX AZ
85016-6873
US

V. Phone/Fax

Practice location:
  • Phone: 480-269-7953
  • Fax: 480-769-7269
Mailing address:
  • Phone: 480-269-7953
  • Fax: 480-769-7269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KYLEE AUSTIN
Title or Position: CO-OWNER
Credential: PT, DPT
Phone: 480-550-1003