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General NPI Number Information
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NPI Number | 1205260924
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Entity Type | Individual
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Provider Name | CHARLIE ALEXANDER FADNESS
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Gender | Male
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 03/14/2014
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Provider Practice Location Address
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Address Line | 2656 SW ROXBURY ST
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City | SEATTLE
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State | WA
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Zip | 98126-4177
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Country | US
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Telephone | 206-937-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 2207 22ND AVE SOUTH
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City | SEATTLE
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State | WA
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Zip | 98144
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Country | US
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Telephone | 206-372-6855
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA 60397088
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License Number State | WA
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