MEDICARE: WILD HEARTH 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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1750250049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILD HEARTH LLC

Provider Business Mailing Address
First Line	:	9906 E 43RD ST STE F
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-4727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9906 E 43RD ST STE F
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-4727
Country	:	US
Telephone Number	:	918-804-9271
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELA MARIE BAUBLIT
Credential	:	LMT
Telephone Number	:	918-804-9271

Provider Enumeration Date	:	11/04/2025
Last Update Date	:	12/17/2025

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Directions to “WILD HEARTH LLC ” Practice Location

Language	Start Address	Practice Location

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