Provider Demographics
NPI:1891895991
Name:NEWMAN, CHARLES ELBERT (LMT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ELBERT
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 E 168TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-3259
Mailing Address - Country:US
Mailing Address - Phone:708-932-8782
Mailing Address - Fax:708-371-4230
Practice Address - Street 1:1225 E 168TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-3259
Practice Address - Country:US
Practice Address - Phone:708-932-8782
Practice Address - Fax:708-371-4230
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist