Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | M00628 | MD |
NPI | 1003413402 |
---|---|
Provider Name | Rhonda Bebout |
First Address | Baltimore, MD 21224 |
Second Address | Baltimore, MD 21224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2020 |
Last Update Date | 08/10/2020 |