Provider Demographics
NPI:1811451172
Name:VERCHER, CHARLES JACOB (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JACOB
Last Name:VERCHER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 WELLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3364
Mailing Address - Country:US
Mailing Address - Phone:318-446-1022
Mailing Address - Fax:
Practice Address - Street 1:433 TIMBERRIDGE DR
Practice Address - Street 2:
Practice Address - City:WOODWORTH
Practice Address - State:LA
Practice Address - Zip Code:71485-9722
Practice Address - Country:US
Practice Address - Phone:318-715-4736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1352765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist