Provider Demographics
NPI:1841069838
Name:POWERS, CHARLOTTE MARIE MARTIN (LMT, MMP)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:MARIE MARTIN
Last Name:POWERS
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 WESTOVER AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-2312
Mailing Address - Country:US
Mailing Address - Phone:540-759-6750
Mailing Address - Fax:
Practice Address - Street 1:117 HERNDON ST
Practice Address - Street 2:
Practice Address - City:FINCASTLE
Practice Address - State:VA
Practice Address - Zip Code:24090-4296
Practice Address - Country:US
Practice Address - Phone:540-759-6750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019017545225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist