Healthcare Provider Details

I. General information

NPI: 1821513045
Provider Name (Legal Business Name): MINDFUL MOBILITY PHYSICAL THERAPY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 DARTMOUTH AVE
SILVER SPRING MD
20910-5540
US

IV. Provider business mailing address

PO BOX 3830
SILVER SPRING MD
20918-3830
US

V. Phone/Fax

Practice location:
  • Phone: 847-858-7767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number871791
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number26189
License Number StateMD

VIII. Authorized Official

Name: KENDALL LYNCH
Title or Position: OWNER
Credential:
Phone: 847-858-7767