Healthcare Provider Details

I. General information

NPI: 1932046281
Provider Name (Legal Business Name): PREMIER INTEGRATIVE HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
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 Number
License Number State

VIII. Authorized Official

Name: ANNETTE BEALE
Title or Position: LEAD STRETCH/MASSAGE THERAPIST
Credential: LMT, MMP
Phone: 240-397-6894