Individual
MR. CHARLES VANCE PHILLIPS IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
25 CHEROKEE BLVD STE C, CHATTANOOGA, TN 37405-3838
(423) 475-6464
Mailing address
25 CHEROKEE BLVD STE C, CHATTANOOGA, TN 37405-3838
(423) 475-6464
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
9355
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9355
TN MASSAGE BOARD
TN
Enumeration date
11/08/2017
Last updated
11/08/2017
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