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General NPI Number Information
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NPI Number | 1558176677
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Entity Type | Organization
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Legal Business Name | MINDBODY HEALTH AND WELLNESS CLINIC
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 100 W 3RD AVE STE B
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City | ELLENSBURG
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State | WA
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Zip | 98926-3354
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Country | US
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Telephone | 509-388-9887
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Fax |
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Provider Business Mailing Address
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Address Line | 100 W 3RD AVE STE B
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City | ELLENSBURG
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State | WA
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Zip | 98926-3354
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Country | US
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Telephone | 509-388-9887
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMI IZZI
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Credential | RN
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Telephone | 509-388-2345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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