Individual
CHARLES WILSON EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MASSAGE THERAPIST
Contact information
Practice address
14828 N 32ND DR, PHOENIX, AZ 85053-4703
(623) 226-2156
Mailing address
14828 N 32ND DR, PHOENIX, AZ 85053-4703
(623) 226-2156
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT-23677
AZ
Other
Enumeration date
04/17/2019
Last updated
06/11/2019
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