=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346553336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOGA WELLNESS WITHIN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2010
-----------------------------------------------------
Last Update Date | 07/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 71 WALNUT RD
-----------------------------------------------------
City | BARRINGTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02806-2110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-743-8490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 71 WALNUT RD
-----------------------------------------------------
City | BARRINGTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02806-2110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-743-8490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. KAREN ANN BOOTH
-----------------------------------------------------
Credential | PTA
-----------------------------------------------------
Telephone | 401-743-8490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | PTA00396
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------