Provider Demographics
NPI:1619268075
Name:BELANGIA, CHARLENE (CMT)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:BELANGIA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMT
Mailing Address - Street 1:3323 S. CRATER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805
Mailing Address - Country:US
Mailing Address - Phone:804-732-2570
Mailing Address - Fax:804-732-2570
Practice Address - Street 1:3323 S. CRATER RD
Practice Address - Street 2:SUITE B
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805
Practice Address - Country:US
Practice Address - Phone:804-732-2570
Practice Address - Fax:804-732-2570
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019009514225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist