Healthcare Provider Details

I. General information

NPI: 1922912401
Provider Name (Legal Business Name): CHARLES BATEMAN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8650 MARTIN WAY E STE 207
LACEY WA
98516-6610
US

IV. Provider business mailing address

8650 MARTIN WAY E STE 207
LACEY WA
98516-6610
US

V. Phone/Fax

Practice location:
  • Phone: 360-951-4504
  • Fax: 877-848-7757
Mailing address:
  • Phone: 360-951-4504
  • Fax: 877-848-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.60904477
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: