Provider Demographics
NPI:1982196176
Name:EWING, GABRIEL (LMT,ROLFER)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:EWING
Suffix:
Gender:M
Credentials:LMT,ROLFER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-1713
Mailing Address - Country:US
Mailing Address - Phone:443-683-1300
Mailing Address - Fax:
Practice Address - Street 1:SANCTUARY BODYWORKS
Practice Address - Street 2:710 S. ANN ST. #210
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231
Practice Address - Country:US
Practice Address - Phone:443-438-3566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM40183225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist