Provider Demographics
NPI:1225217516
Name:MIND & BODY THERAPUTICS,INC.
Entity Type:Organization
Organization Name:MIND & BODY THERAPUTICS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-758-7827
Mailing Address - Street 1:2 FRANK ST
Mailing Address - Street 2:
Mailing Address - City:E PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5908
Mailing Address - Country:US
Mailing Address - Phone:631-758-7827
Mailing Address - Fax:
Practice Address - Street 1:755 WAVERLY AVE
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1190
Practice Address - Country:US
Practice Address - Phone:631-758-7827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health