Provider Demographics
NPI:1588176457
Name:MINDFUL HEALTH & WELLNESS
Entity Type:Organization
Organization Name:MINDFUL HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:T
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-802-4762
Mailing Address - Street 1:3800 BOULDER CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-3792
Mailing Address - Country:US
Mailing Address - Phone:410-802-4762
Mailing Address - Fax:
Practice Address - Street 1:3800 BOULDER CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3792
Practice Address - Country:US
Practice Address - Phone:410-802-4762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245740760OtherNPI