MEDICARE: MIND BODY UNITY LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1316600141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND BODY UNITY LLC

Provider Business Mailing Address
First Line	:	2424 INDIA HOOK RD STE 140
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1278
Country	:	US
Telephone Number	:	803-339-9504
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 INDIA HOOK RD STE 140
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1278
Country	:	US
Telephone Number	:	803-339-9504
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. GEORGETTE T FUHR
Credential	:	LISW-CP
Telephone Number	:	803-339-9504

Provider Enumeration Date	:	10/19/2021
Last Update Date	:	10/19/2021

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