MEDICARE: CHARLIE J WARE JR. LMT, DOM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AP 2677	FL
2	225700000X	Massage Therapist	MA 41564	FL

General Provider Information

NPI Number	:	1538292008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLIE J WARE JR. LMT, DOM

Provider Business Mailing Address
First Line	:	2632 HOLLYWOOD BLVD
Second Line	:	SUITE 300
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4857
Country	:	US
Telephone Number	:	305-498-4483
Fax Number	:	954-458-5990

Provider Business Practice Location Address
First Line	:	2632 HOLLYWOOD BLVD
Second Line	:	SUITE 300
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4857
Country	:	US
Telephone Number	:	305-498-4483
Fax Number	:	954-458-5990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/23/2014

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