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General NPI Number Information
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NPI Number | 1336106343
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Entity Type | Organization
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Legal Business Name | WIND PALACE HEALING ARTS, INC.
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2411 CROFTON LN
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City | CROFTON
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State | MD
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Zip | 21114-1304
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Country | US
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Telephone | 410-991-6805
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Fax |
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Provider Business Mailing Address
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Address Line | 2317 HALLS GROVE RD
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City | GAMBRILLS
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State | MD
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Zip | 21054-1953
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Country | US
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Telephone | 410-451-3943
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MRS. GAIL Y. BOZZELLA
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Credential | M.AC., L.AC.
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Telephone | 410-991-6805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | U01031
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License Number State | MD
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