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General NPI Number Information
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NPI Number | 1750891206
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Entity Type | Individual
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Provider Name | CHARLA LEE SWEAT RRT, LMT
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Gender | Female
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 10/10/2017
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Provider Practice Location Address
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Address Line | 6290 JUPITER DRIVE SUITE C
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City | BELMONT
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State | MI
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Zip | 49306
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Country | US
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Telephone | 616-724-7613
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Fax |
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Provider Business Mailing Address
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Address Line | 3751 BRIGGS BLVD NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-2182
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Country | US
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Telephone | 616-724-7613
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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 |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 7501005958
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License Number State | MI
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