Healthcare Provider Details

I. General information

NPI: 1992628531
Provider Name (Legal Business Name): MIND BODY HEALTH & WELLNESS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 CENTER ST W
ROSEAU MN
56751-1419
US

IV. Provider business mailing address

308 CENTER ST W
ROSEAU MN
56751-1419
US

V. Phone/Fax

Practice location:
  • Phone: 218-463-1070
  • Fax:
Mailing address:
  • Phone: 218-463-1070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: NGHI TRINH-PHAM
Title or Position: OWNER
Credential:
Phone: 218-463-1070