NPI 1346464419

Charles William Street, MASSAGETHERAPIST

Practitioner Specialist Beaverton, OR

Practice location

Address: 1060 SW 170th Ave Unit 200, Beaverton, OR 97006-8089
Phone: (541) 778-0705
Fax: (541) 608-3911

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence 1002 (OR)

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Registry record

NPI: 1346464419
Entity type: Individual
Sex (as registered): Male
NPI issued: 12 Apr 2007
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.