Individual
CHARLES W. WILTSIE III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
955 S MAIN ST, MIDDLETOWN, CT 06457-5153
(860) 638-9286
Mailing address
955 S MAIN ST, MIDDLETOWN, CT 06457-5153
(860) 638-9286
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
000254
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000254
CONNECTICUT DEPARTMENT OF HEALTH
CT
Enumeration date
10/02/2019
Last updated
10/02/2019
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