Healthcare Provider Details

I. General information

NPI: 1154236743
Provider Name (Legal Business Name): MYOSOUL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 MAIN ST
LEWISTON ME
04240-5807
US

IV. Provider business mailing address

180 WALNUT ST
LEWISTON ME
04240-6440
US

V. Phone/Fax

Practice location:
  • Phone: 207-312-3247
  • Fax:
Mailing address:
  • Phone: 207-312-3247
  • 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: MS. SARAH ELIZABETH BUNNITT
Title or Position: OWNER
Credential: MT
Phone: 207-312-3247