Provider Demographics
NPI:1811209083
Name:REDMON, CHARLOTTE JEAN (CMT)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:JEAN
Last Name:REDMON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:MRS
Other - First Name:CHARLOTTE
Other - Middle Name:JEAN
Other - Last Name:VILLEGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:57475 29 PALMS HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2906
Mailing Address - Country:US
Mailing Address - Phone:760-365-9878
Mailing Address - Fax:206-309-0387
Practice Address - Street 1:57475 29 PALMS HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2906
Practice Address - Country:US
Practice Address - Phone:760-365-9878
Practice Address - Fax:206-309-0387
Is Sole Proprietor?:No
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1796172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1796OtherCERTIFIED MASSAGE THERAPIST