Provider Demographics
NPI:1871953679
Name:THE HEALING TEMPLE LLC
Entity type:Organization
Organization Name:THE HEALING TEMPLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILEANA
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:SUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-448-7945
Mailing Address - Street 1:11 W PATRICK ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5511
Mailing Address - Country:US
Mailing Address - Phone:301-448-7945
Mailing Address - Fax:
Practice Address - Street 1:11 W PATRICK ST
Practice Address - Street 2:SUITE 300
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5511
Practice Address - Country:US
Practice Address - Phone:301-448-7945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM02825225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty