Provider Demographics
NPI:1376928895
Name:SANTOS, CHARITY (LMP, CNA, CPT)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:LMP, CNA, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5003 15TH AVE NE
Mailing Address - Street 2:APT 105
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4345
Mailing Address - Country:US
Mailing Address - Phone:360-349-1834
Mailing Address - Fax:
Practice Address - Street 1:150 MELROSE AVE E
Practice Address - Street 2:APT 208
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-5549
Practice Address - Country:US
Practice Address - Phone:360-349-1834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60542569225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist