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General NPI Number Information
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NPI Number | 1700425949
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Entity Type | Individual
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Provider Name | CHARLES GEORGE KING JR. LMT
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Gender | Male
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Dates
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Enumeration Date | 01/06/2020
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Last Update Date | 01/06/2020
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Provider Practice Location Address
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Address Line | 6223 N 20TH DR
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City | PHOENIX
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State | AZ
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Zip | 85015-1516
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Country | US
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Telephone | 480-518-2090
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Fax | 855-518-2090
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Provider Business Mailing Address
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Address Line | 3905 N 7TH AVE UNIT 34965
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City | PHOENIX
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State | AZ
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Zip | 85013-3368
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Country | US
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Telephone | 480-518-2090
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Fax | 855-518-2090
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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 | MT-09329
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License Number State | AZ
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