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General NPI Number Information
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NPI Number | 1033086434
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Entity Type | Organization
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Legal Business Name | MENDED WILLOW
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 108 HAY ST STE 221
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-5686
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Country | US
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Telephone | 910-286-2603
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Fax | 910-595-6014
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Provider Business Mailing Address
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Address Line | 108 HAY ST STE 221
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-5686
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Country | US
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Telephone | 910-286-2603
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Fax | 910-565-6014
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Authorized Official
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Title or Position | OWNER / MEMBER
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Name | ANDREA L FLOWERS
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Credential | LMBT,MMP
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Telephone | 910-286-2603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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