Provider Demographics
NPI:1083636195
Name:HOULDING, CHARLES W (MSPT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:HOULDING
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2462A MISTY FJORD CT
Mailing Address - Street 2:
Mailing Address - City:EIELSON AFB
Mailing Address - State:AK
Mailing Address - Zip Code:99702-3101
Mailing Address - Country:US
Mailing Address - Phone:907-372-4980
Mailing Address - Fax:
Practice Address - Street 1:2360 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EIELSON AFB
Practice Address - State:AK
Practice Address - Zip Code:99702-2325
Practice Address - Country:US
Practice Address - Phone:907-377-6627
Practice Address - Fax:907-377-4379
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist