Provider Demographics
NPI:1659551554
Name:WICHSER, CHARLES D (LMP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
Last Name:WICHSER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 S GRAND BLVD STE 101S
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2272
Mailing Address - Country:US
Mailing Address - Phone:509-838-2225
Mailing Address - Fax:509-755-2225
Practice Address - Street 1:1403 S GRAND BLVD STE 101S
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2272
Practice Address - Country:US
Practice Address - Phone:509-838-2225
Practice Address - Fax:509-755-2225
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022360225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist