Healthcare Provider Details

I. General information

NPI: 1508795691
Provider Name (Legal Business Name): MINDFUL MOTION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 BRANDY SPRINGS RD
PARKTON MD
21120-9748
US

IV. Provider business mailing address

1209 BRANDY SPRINGS RD
PARKTON MD
21120-9748
US

V. Phone/Fax

Practice location:
  • Phone: 410-375-9493
  • Fax:
Mailing address:
  • Phone: 410-375-9493
  • 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: MRS. CORINNE ALYSON ROTH
Title or Position: PHYSICAL THERAPIST
Credential: MSPT
Phone: 410-375-9493