Provider Demographics
NPI:1962828392
Name:CRANE, CHARLES SEAMUS (MASSMA60007096)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:SEAMUS
Last Name:CRANE
Suffix:
Gender:M
Credentials:MASSMA60007096
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 3RD AVE STE 145
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-6004
Mailing Address - Country:US
Mailing Address - Phone:360-575-8897
Mailing Address - Fax:
Practice Address - Street 1:1157 3RD AVE STE 145
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-6004
Practice Address - Country:US
Practice Address - Phone:360-575-8897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMASS.MA.60007096225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist