Healthcare Provider Details

I. General information

NPI: 1669316386
Provider Name (Legal Business Name): ANNETTE BEALE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E CHURCH ST
FREDERICK MD
21701-5705
US

IV. Provider business mailing address

605 E CHURCH ST
FREDERICK MD
21701-5705
US

V. Phone/Fax

Practice location:
  • Phone: 240-397-6894
  • Fax:
Mailing address:
  • Phone: 240-397-6894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM06396
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: