Provider Demographics
NPI:1518260736
Name:MUNROE, CHARMAINE G (LMT)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:G
Last Name:MUNROE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13455 SW 16TH CT
Mailing Address - Street 2:F103
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1878
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13455 SW 16TH CT
Practice Address - Street 2:F103
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1878
Practice Address - Country:US
Practice Address - Phone:954-850-0570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA29283173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA29283OtherDEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE