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General NPI Number Information
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NPI Number | 1831025378
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Entity Type | Organization
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Legal Business Name | WILD VINE WELLNESS
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Dates
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Enumeration Date | 06/22/2026
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Last Update Date | 06/22/2026
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Provider Practice Location Address
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Address Line | 3331 W BROADWAY ST
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City | PRINCETON
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State | IN
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Zip | 47670-8573
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Country | US
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Telephone | 812-316-5025
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Fax |
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Provider Business Mailing Address
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Address Line | 6405 S LAFFERTY RD
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City | VINCENNES
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State | IN
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Zip | 47591-9103
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Country | US
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Telephone | 812-316-5025
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | DR. JESSY ROBBINS
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Credential | PHD, LMT, RYT
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Telephone | 812-316-5025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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