Healthcare Provider Details

I. General information

NPI: 1033077003
Provider Name (Legal Business Name): MINDY'S WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 W TOWN PL STE 105
SAINT AUGUSTINE FL
32092-3649
US

IV. Provider business mailing address

475 W TOWN PL STE 105
SAINT AUGUSTINE FL
32092-3649
US

V. Phone/Fax

Practice location:
  • Phone: 904-680-7328
  • Fax:
Mailing address:
  • Phone: 904-680-7328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MINDY L MILTON
Title or Position: CEO
Credential: LMT
Phone: 904-680-7328