Provider Demographics
NPI:1548341845
Name:MINDFUL MOVEMENT & PHYSICAL THERAPY, L.L.C.
Entity type:Organization
Organization Name:MINDFUL MOVEMENT & PHYSICAL THERAPY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOLYNN
Authorized Official - Middle Name:MARIE - CANFIELD
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:517-323-1682
Mailing Address - Street 1:2740 E LANSING DR
Mailing Address - Street 2:STE. B
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-7754
Mailing Address - Country:US
Mailing Address - Phone:517-323-1682
Mailing Address - Fax:
Practice Address - Street 1:2740 E LANSING DR
Practice Address - Street 2:STE. B
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-7754
Practice Address - Country:US
Practice Address - Phone:517-323-1682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty