Provider Demographics
NPI:1962835603
Name:PATTON, CHARLES LEWIS III (LMT, NCTMB)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LEWIS
Last Name:PATTON
Suffix:III
Gender:M
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N ST SW
Mailing Address - Street 2:APT 420
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-3525
Mailing Address - Country:US
Mailing Address - Phone:202-412-7444
Mailing Address - Fax:
Practice Address - Street 1:203 N ST SW
Practice Address - Street 2:APT 420
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3525
Practice Address - Country:US
Practice Address - Phone:202-412-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT1511225700000X
VA0019010788225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist