Healthcare Provider Details

I. General information

NPI: 1417884974
Provider Name (Legal Business Name): EARTHSTEPS WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 ROSEWOOD CT
DAVIE FL
33328-6764
US

IV. Provider business mailing address

3120 ROSEWOOD CT
DAVIE FL
33328-6764
US

V. Phone/Fax

Practice location:
  • Phone: 954-998-3071
  • Fax:
Mailing address:
  • Phone: 954-998-3071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SARA GRENALD
Title or Position: OWNER
Credential: LCSW
Phone: 305-998-9728