Provider Demographics
NPI:1770819427
Name:PADRON, CHARLEE RACHELLE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CHARLEE
Middle Name:RACHELLE
Last Name:PADRON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 SAN MARIO CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-6584
Mailing Address - Country:US
Mailing Address - Phone:979-703-6758
Mailing Address - Fax:
Practice Address - Street 1:625 SAN MARIO CT
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6584
Practice Address - Country:US
Practice Address - Phone:979-703-6758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT105934225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist