Healthcare Provider Details

I. General information

NPI: 1831025378
Provider Name (Legal Business Name): WILD VINE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 W BROADWAY ST
PRINCETON IN
47670-8573
US

IV. Provider business mailing address

6405 S LAFFERTY RD
VINCENNES IN
47591-9103
US

V. Phone/Fax

Practice location:
  • Phone: 812-316-5025
  • Fax:
Mailing address:
  • Phone: 812-316-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSY ROBBINS
Title or Position: LICENSED MASSAGE THERAPIST
Credential: PHD, LMT, RYT
Phone: 812-316-5025