Provider Demographics
NPI:1841154176
Name:MINDFUL MOTION THERAPIES, LLC
Entity type:Organization
Organization Name:MINDFUL MOTION THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECREATION THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHYENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHYENNE
Authorized Official - Suffix:
Authorized Official - Credentials:CTRS
Authorized Official - Phone:601-307-2437
Mailing Address - Street 1:5417 TUXBURY POND DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1490
Mailing Address - Country:US
Mailing Address - Phone:601-307-2437
Mailing Address - Fax:601-307-2437
Practice Address - Street 1:5417 TUXBURY POND DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-1490
Practice Address - Country:US
Practice Address - Phone:601-307-2437
Practice Address - Fax:601-307-2437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-11
Last Update Date:2025-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty