Provider Demographics
NPI:1073845533
Name:MIND-BODY THERAPY INC.
Entity Type:Organization
Organization Name:MIND-BODY THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAIR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:407-463-9284
Mailing Address - Street 1:3844 IRONWEDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-3041
Mailing Address - Country:US
Mailing Address - Phone:407-463-9284
Mailing Address - Fax:407-296-7105
Practice Address - Street 1:3844 IRONWEDGE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-3041
Practice Address - Country:US
Practice Address - Phone:407-463-9284
Practice Address - Fax:407-296-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty