Provider Demographics
NPI:1083414858
Name:FREDERICK REFLEXOLOGY LLC
Entity type:Organization
Organization Name:FREDERICK REFLEXOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LARA
Authorized Official - Middle Name:LYNN ROHOLT
Authorized Official - Last Name:WESTDORP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-732-1039
Mailing Address - Street 1:6640 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-5816
Mailing Address - Country:US
Mailing Address - Phone:301-371-8556
Mailing Address - Fax:
Practice Address - Street 1:129 13 WEST PATRICK STREET
Practice Address - Street 2:SUITE 2C
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701
Practice Address - Country:US
Practice Address - Phone:301-732-1039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173C00000XOther Service ProvidersReflexologistGroup - Single Specialty