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General NPI Number Information
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NPI Number | 1396869855
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Entity Type | Individual
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Provider Name | CHARLES WAYNE WINCHELL L.M.T.
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 722 MARTIN LUTHER KING AVE.
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City | TACOMA
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State | WA
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Zip | 98403
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Country | US
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Telephone | 253-548-4015
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 150
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City | YELM
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State | WA
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Zip | 98597-0150
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Country | US
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Telephone | 360-894-5686
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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 | 024201
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License Number State | WA
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