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General NPI Number Information
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NPI Number | 1497029441
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Entity Type | Organization
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Legal Business Name | MIND YOUR BODY HOLISTIC HEALTH LLC
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Dates
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Enumeration Date | 03/07/2012
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 288 WALNUT ST SUITE 420
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City | NEWTON
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State | MA
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Zip | 02460-1948
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Country | US
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Telephone | 617-969-1034
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Fax |
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Provider Business Mailing Address
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Address Line | 288 WALNUT ST SUITE 420
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City | NEWTON
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State | MA
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Zip | 02460-1948
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Country | US
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Telephone | 617-969-1034
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MITZIE LADD
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Credential | LMT
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Telephone | 617-969-1034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | 7569
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License Number State | MA
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