NPI 1679291538 · live from the CMS NPI Registry
Frederick Michael Dedolph, LMT
Massage Therapist in Columbia, MD. National Provider Identifier 1679291538, active.
NPI record
| NPI | 1679291538 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Massage Therapist 225700000X |
| Practice location | 5615 Suffield Ct, Columbia, MD 21044 |
| Practice phone | 412-477-7163 |
| Enumerated | August 17, 2022 |
| Last updated | September 13, 2022 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Massage Therapist | 225700000X | MSG002338 (PA) |
| Massage Therapist primary | 225700000X | M05957 (MD) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.