Healthcare Provider Details

I. General information

NPI: 1417359332
Provider Name (Legal Business Name): MINDBODY HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 N LARCHMONT BLVD
LOS ANGELES CA
90004-3013
US

IV. Provider business mailing address

403 N LARCHMONT BLVD
LOS ANGELES CA
90004-3013
US

V. Phone/Fax

Practice location:
  • Phone: 818-402-8898
  • Fax:
Mailing address:
  • Phone: 818-402-8898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ERIN J. POWERS
Title or Position: PRESIDENT
Credential:
Phone: 818-402-8898