Healthcare Provider Details

I. General information

NPI: 1962763482
Provider Name (Legal Business Name): CHERYL ANN IMPERATORE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14411 CHRISMAN HILL DR
BOYDS MD
20841-9038
US

IV. Provider business mailing address

14411 CHRISMAN HILL DR
BOYDS MD
20841-9038
US

V. Phone/Fax

Practice location:
  • Phone: 301-802-0830
  • Fax:
Mailing address:
  • Phone: 301-802-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM02818
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: