Provider Demographics
NPI:1689366148
Name:PHOENIX BODY & MIND, LLC
Entity Type:Organization
Organization Name:PHOENIX BODY & MIND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:FLANNERY
Authorized Official - Last Name:BRAMLETT
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:407-790-1517
Mailing Address - Street 1:547 E NEW YORK AVE STE D
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-6081
Mailing Address - Country:US
Mailing Address - Phone:386-873-2431
Mailing Address - Fax:
Practice Address - Street 1:547 E NEW YORK AVE STE D
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-6081
Practice Address - Country:US
Practice Address - Phone:386-873-2431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty