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General NPI Number Information
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NPI Number | 1164437828
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Entity Type | Organization
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Legal Business Name | MIND BODY PHYSICAL THERAPY & WELLNESS CENTER, INC.
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 11/28/2016
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Provider Practice Location Address
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Address Line | 1400 COPPERMINE TER TERRACE
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City | BALTIMORE
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State | MD
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Zip | 21209-2012
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Country | US
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Telephone | 443-279-1777
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 COPPERMINE TER
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City | BALTIMORE
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State | MD
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Zip | 21209-2012
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Country | US
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Telephone | 443-279-1777
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Fax |
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Authorized Official
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Title or Position | OWNER/OFFICE MANAGER
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Name | WENDY A QUITASOL
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Credential | PT
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Telephone | 443-279-1777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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