Provider Demographics
NPI:1346883956
Name:MINDFUL MOBILITY
Entity Type:Organization
Organization Name:MINDFUL MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-754-6202
Mailing Address - Street 1:4138 S 950 E
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2968
Mailing Address - Country:US
Mailing Address - Phone:435-754-6202
Mailing Address - Fax:
Practice Address - Street 1:2690 PENNSYLVANIA AVE UNIT 7
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-3384
Practice Address - Country:US
Practice Address - Phone:385-264-2089
Practice Address - Fax:877-795-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-26
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies