Provider Demographics
NPI:1114975703
Name:NEWBY, CHARLES W (PT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:NEWBY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 N HERCULES AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-4403
Mailing Address - Country:US
Mailing Address - Phone:727-797-8100
Mailing Address - Fax:727-797-8110
Practice Address - Street 1:1944 N HERCULES AVE STE C
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-4403
Practice Address - Country:US
Practice Address - Phone:727-797-8100
Practice Address - Fax:727-797-8110
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2298225100000X
FLPT20271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1114975703OtherNPI
AL51524069OtherBLUE CROSS BLUE SHIELD