MEDICARE: MINDFUL MOBILITY PHYSICAL THERAPY & WELLNESS

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	261QP2000X	Physical Therapy Clinic/Center	871791	DC
2	261QP2000X	Physical Therapy Clinic/Center	26189	MD

General Provider Information

NPI Number	:	1821513045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL MOBILITY PHYSICAL THERAPY & WELLNESS

Provider Business Mailing Address
First Line	:	PO BOX 3830
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20918-3830
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	713 DARTMOUTH AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-5540
Country	:	US
Telephone Number	:	847-858-7767
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KENDALL LYNCH
Credential	:
Telephone Number	:	847-858-7767

Provider Enumeration Date	:	08/09/2017
Last Update Date	:	08/09/2017

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