Provider Demographics
NPI:1558751636
Name:RANGEL, CELSO JR
Entity Type:Individual
Prefix:
First Name:CELSO
Middle Name:
Last Name:RANGEL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2176
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-5047
Mailing Address - Country:US
Mailing Address - Phone:360-426-8060
Mailing Address - Fax:360-427-5819
Practice Address - Street 1:1635 OLYMPIC HWY N
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-3065
Practice Address - Country:US
Practice Address - Phone:360-426-8060
Practice Address - Fax:360-427-5819
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60533051225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist