Provider Demographics
NPI:1659044170
Name:MIND. BODY. SPIRIT. LLC
Entity Type:Organization
Organization Name:MIND. BODY. SPIRIT. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:CORTNI
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:601-529-8829
Mailing Address - Street 1:114 LINDA DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-8909
Mailing Address - Country:US
Mailing Address - Phone:601-272-1756
Mailing Address - Fax:601-272-1756
Practice Address - Street 1:114 LINDA DR
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-8909
Practice Address - Country:US
Practice Address - Phone:601-272-1756
Practice Address - Fax:601-272-1756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty