Healthcare Provider Details

I. General information

NPI: 1891868444
Provider Name (Legal Business Name): CHARLIE FRANKLIN M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 CATALPA DR
ROYAL OAK MI
48067-1125
US

IV. Provider business mailing address

21102 GREENVIEW RD
SOUTHFIELD MI
48075-7118
US

V. Phone/Fax

Practice location:
  • Phone: 248-569-6578
  • Fax:
Mailing address:
  • Phone: 248-569-6537
  • Fax: 248-809-9948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: