MEDICARE: MINDFUL MOTION THERAPIES, 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	225800000X	Recreation Therapist

General Provider Information

NPI Number	:	1841154176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL MOTION THERAPIES, LLC

Provider Business Mailing Address
First Line	:	5417 TUXBURY POND DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-1490
Country	:	US
Telephone Number	:	601-307-2437
Fax Number	:	601-307-2437

Provider Business Practice Location Address
First Line	:	5417 TUXBURY POND DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-1490
Country	:	US
Telephone Number	:	601-307-2437
Fax Number	:	601-307-2437

Authorized Official
Title or Position	:	RECREATION THERAPIST
Name	:	CHYENNE CHYENNE
Credential	:	CTRS
Telephone Number	:	601-307-2437

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

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