Healthcare Provider Details

I. General information

NPI: 1477798809
Provider Name (Legal Business Name): CHARLTON C VASS L.M.T./N.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 WESTMORELAND ST
HARROGATE TN
37752-8202
US

IV. Provider business mailing address

169 WESTMORELAND ST
HARROGATE TN
37752-8202
US

V. Phone/Fax

Practice location:
  • Phone: 423-869-3700
  • Fax: 423-869-5555
Mailing address:
  • Phone: 423-869-3700
  • Fax: 423-869-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1888
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: