MEDICARE: MENDED WILLOW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1033086434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENDED WILLOW

Provider Business Mailing Address
First Line	:	108 HAY ST STE 221
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-5686
Country	:	US
Telephone Number	:	910-286-2603
Fax Number	:	910-565-6014

Provider Business Practice Location Address
First Line	:	108 HAY ST STE 221
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-5686
Country	:	US
Telephone Number	:	910-286-2603
Fax Number	:	910-595-6014

Authorized Official
Title or Position	:	OWNER / MEMBER
Name	:	ANDREA L FLOWERS
Credential	:	LMBT,MMP
Telephone Number	:	910-286-2603

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	10/20/2025

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Directions to “MENDED WILLOW ” Practice Location

Language	Start Address	Practice Location

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