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General NPI Number Information
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NPI Number | 1710868302
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Entity Type | Organization
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Legal Business Name | MIND BODY PILATES & PHYSICAL THERAPY, L.L.C.
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 62018 SAVANNAH DR
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City | SOUTH LYON
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State | MI
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Zip | 48178-0738
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Country | US
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Telephone | 219-742-2782
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Fax |
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Provider Business Mailing Address
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Address Line | 62018 SAVANNAH DR
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City | SOUTH LYON
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State | MI
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Zip | 48178-0738
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | NICOLE KESKITALO
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Credential |
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Telephone | 219-742-2782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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