Healthcare Provider Details

I. General information

NPI: 1730050980
Provider Name (Legal Business Name): RUTH ANNE EADDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 SMOOTH ALDER ST N APT 322
GAMBRILLS MD
21054-1370
US

IV. Provider business mailing address

2610 SMOOTH ALDER ST N APT 322
GAMBRILLS MD
21054-1370
US

V. Phone/Fax

Practice location:
  • Phone: 301-456-9835
  • Fax:
Mailing address:
  • Phone: 301-456-9835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM03717
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: