Provider Demographics
NPI:1093922403
Name:BODY AND SOUL THERAPY
Entity Type:Organization
Organization Name:BODY AND SOUL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WYTTENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:952-830-4615
Mailing Address - Street 1:7200 FRANCE AVE S
Mailing Address - Street 2:SUITE 227
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4300
Mailing Address - Country:US
Mailing Address - Phone:952-830-4615
Mailing Address - Fax:
Practice Address - Street 1:7200 FRANCE AVE S
Practice Address - Street 2:SUITE 227
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4300
Practice Address - Country:US
Practice Address - Phone:952-830-4615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102921225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty