Individual
MR. CHARLES D. AVERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
120 SECOND AVE E., SUPERIOR, MT 59872
(406) 822-1040
Mailing address
POST OFFICE BOX 784, SUPERIOR, MT 59872
(406) 822-1040
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LMT-LMT-LIC6171
MT
Other
Enumeration date
08/15/2014
Last updated
08/15/2014
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