Healthcare Provider Details

I. General information

NPI: 1669190823
Provider Name (Legal Business Name): SYNERGIES RETREAT STUDIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N CHARLES STREET SUITE 105
BALTIMORE MD
21201-5592
US

IV. Provider business mailing address

1120 N CHARLES STREET SUITE 105
BALTIMORE MD
21201-5592
US

V. Phone/Fax

Practice location:
  • Phone: 443-226-5719
  • Fax: 443-652-6307
Mailing address:
  • Phone: 443-226-5719
  • Fax: 443-652-6307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. LAMAR B MATTHEWS
Title or Position: OWNER & OPERATOR
Credential: LMT
Phone: 443-226-5719