Provider Demographics
NPI:1801113212
Name:UPMEYER, CHARLES ALLEN (LMP)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALLEN
Last Name:UPMEYER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16240 NE 14TH ST
Mailing Address - Street 2:C-11
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-2870
Mailing Address - Country:US
Mailing Address - Phone:425-765-1370
Mailing Address - Fax:
Practice Address - Street 1:16240 NE 14TH ST
Practice Address - Street 2:C-11
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2870
Practice Address - Country:US
Practice Address - Phone:425-765-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-24
Last Update Date:2010-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60146621225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist