Provider Demographics
NPI:1720623739
Name:ROZICH, CHARLOTTE CHRISTINA (LMT, NCTMB)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:CHRISTINA
Last Name:ROZICH
Suffix:
Gender:F
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 1:115 S EVANS ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-1949
Mailing Address - Country:US
Mailing Address - Phone:517-442-0108
Mailing Address - Fax:
Practice Address - Street 1:115 S EVANS ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-1949
Practice Address - Country:US
Practice Address - Phone:517-442-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501008247225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist