Provider Demographics
NPI:1538292008
Name:WARE, CHARLIE J JR (LMT, DOM)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:J
Last Name:WARE
Suffix:JR
Gender:M
Credentials:LMT, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2632 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4857
Mailing Address - Country:US
Mailing Address - Phone:305-498-4483
Mailing Address - Fax:954-458-5990
Practice Address - Street 1:2632 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4857
Practice Address - Country:US
Practice Address - Phone:305-498-4483
Practice Address - Fax:954-458-5990
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2677171100000X
FLMA 41564225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist