Healthcare Provider Details

I. General information

NPI: 1003413402
Provider Name (Legal Business Name): RHONDA BEBOUT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S HIGHLAND AVE 600 B
BALTIMORE MD
21224
US

IV. Provider business mailing address

600 S HIGHLAND AVE 600 B
BALTIMORE MD
21224
US

V. Phone/Fax

Practice location:
  • Phone: 443-220-8336
  • Fax:
Mailing address:
  • Phone: 443-220-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM00628
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: