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General NPI Number Information
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NPI Number | 1871428664
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Entity Type | Individual
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Provider Name | CHARLES ROBERT MASEWICZ
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Gender | Male
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Dates
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Enumeration Date | 06/15/2026
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Last Update Date | 06/15/2026
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Provider Practice Location Address
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Address Line | 410 BENEDICTA AVE
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City | TRINIDAD
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State | CO
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Zip | 81082-2005
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Country | US
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Telephone | 719-846-9213
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Fax |
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Provider Business Mailing Address
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Address Line | W5750 SHERWOOD DR
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City | LA CROSSE
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State | WI
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Zip | 54601-8442
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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