Individual
MR. CHARLES WILLIAM STREET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MASSAGE THERAPIST
Contact information
Practice address
1060 SW 170TH AVE UNIT 200, BEAVERTON, OR 97006-8089
(541) 778-0705
(541) 608-3911
Mailing address
1060 SW 170TH AVE UNIT 200, BEAVERTON, OR 97006-8089
(541) 778-0705
(541) 608-3911
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1002
OR
Other
Enumeration date
04/12/2007
Last updated
07/08/2007
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