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General NPI Number Information
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NPI Number | 1710850326
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Entity Type | Organization
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Legal Business Name | WILLIEMAE MIND & BODY INC DBA STRETCHLAB FIRST COAST
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 1059 A1A BEACH BLVD
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-6732
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Country | US
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Telephone | 904-490-9242
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 FLAMINGO ST
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-9114
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Country | US
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Telephone | 904-490-8766
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DAVID RAMOS
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Credential |
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Telephone | 904-490-8766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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