Healthcare Provider Details

I. General information

NPI: 1245532647
Provider Name (Legal Business Name): JUST BREATHE, A WELLNESS SANCTUARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4203 E INDIAN SCHOOL RD SUITE 300
PHOENIX AZ
85018-5359
US

IV. Provider business mailing address

PO BOX 10342
PHOENIX AZ
85064-0342
US

V. Phone/Fax

Practice location:
  • Phone: 602-256-1400
  • Fax: 800-256-7157
Mailing address:
  • Phone: 602-256-1400
  • Fax: 800-256-7157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMT-13334
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1744G0900X
TaxonomyGraphics Designer
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMT-09712
License Number StateAZ

VIII. Authorized Official

Name: MR. MICHAEL CARY MINKUS
Title or Position: OWNER
Credential:
Phone: 602-256-1400