Provider Demographics
NPI:1801330469
Name:DENEEN, CHARLES JR (DPT)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:DENEEN
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 W US HIGHWAY 30
Mailing Address - Street 2:E
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-3364
Mailing Address - Country:US
Mailing Address - Phone:712-794-7939
Mailing Address - Fax:
Practice Address - Street 1:303 E BASELINE RD STE 101
Practice Address - Street 2:101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6561
Practice Address - Country:US
Practice Address - Phone:602-243-1476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist