Provider Demographics
NPI:1942197876
Name:WILDFLOWER MIND-BODY THERAPY LLC
Entity type:Organization
Organization Name:WILDFLOWER MIND-BODY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAILEY
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:253-904-4737
Mailing Address - Street 1:531B HOTCHKISS RD
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-8713
Mailing Address - Country:US
Mailing Address - Phone:253-904-4737
Mailing Address - Fax:
Practice Address - Street 1:298 S MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2416
Practice Address - Country:US
Practice Address - Phone:509-680-1518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty