Healthcare Provider Details

I. General information

NPI: 1508722109
Provider Name (Legal Business Name): MINDFULNESS IN MOTION PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325B CORDOVA ST STE 1
PASADENA CA
91101
US

IV. Provider business mailing address

2315 1/2 MERTON AVE
LOS ANGELES CA
90041-1916
US

V. Phone/Fax

Practice location:
  • Phone: 516-527-2284
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MELIA FLAGG
Title or Position: OWNER
Credential:
Phone: 516-527-2284