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General NPI Number Information
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NPI Number | 1043833825
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Entity Type | Individual
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Provider Name | CHARLES WEBSTER JR
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Gender | Male
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Dates
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Enumeration Date | 05/27/2020
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 950 CHERRY RD
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City | MEMPHIS
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State | TN
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Zip | 38117-5431
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Country | US
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Telephone | 901-930-0817
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Fax |
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Provider Business Mailing Address
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Address Line | 599C STEED RD
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City | RIDGELAND
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State | MS
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Zip | 39157-1707
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Country | US
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Telephone | 601-605-6777
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Fax | 601-813-5460
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 13046
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License Number State | TN
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