Provider Demographics
NPI:1750671012
Name:DEVILLE, CHARLES MARTIN ERRUSARD II (LMP)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:MARTIN ERRUSARD
Last Name:DEVILLE
Suffix:II
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 1:4729 149TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-3127
Mailing Address - Country:US
Mailing Address - Phone:425-647-4231
Mailing Address - Fax:
Practice Address - Street 1:4729 149TH AVE SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-3127
Practice Address - Country:US
Practice Address - Phone:425-647-4231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60163281225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist