Healthcare Provider Details

I. General information

NPI: 1346883956
Provider Name (Legal Business Name): MINDFUL MOBILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2019
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 W RIVERDALE RD STE B4
RIVERDALE UT
84405-3760
US

IV. Provider business mailing address

4138 S 950 E
OGDEN UT
84403-2968
US

V. Phone/Fax

Practice location:
  • Phone: 435-380-3231
  • Fax: 877-795-4950
Mailing address:
  • Phone: 435-754-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL

VIII. Authorized Official

Name: NATHANIEL M STEPHENS
Title or Position: MEMBER
Credential:
Phone: 435-754-6202