Healthcare Provider Details

I. General information

NPI: 1841101631
Provider Name (Legal Business Name): MR. CHARLES EDWARD CRISWELL II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7823 S CAESAR DR
TUCSON AZ
85747-5128
US

IV. Provider business mailing address

7823 S CAESAR DR
TUCSON AZ
85747-5128
US

V. Phone/Fax

Practice location:
  • Phone: 520-332-4191
  • Fax:
Mailing address:
  • Phone: 520-332-4191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-51237
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: