Provider Demographics
NPI:1063194223
Name:MORETTI, CHARLES (LMT, RYT)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:MORETTI
Suffix:
Gender:M
Credentials:LMT, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7557 ARLINGTON EXPY APT A101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5901
Mailing Address - Country:US
Mailing Address - Phone:904-763-3115
Mailing Address - Fax:
Practice Address - Street 1:7557 ARLINGTON EXPY APT A101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5901
Practice Address - Country:US
Practice Address - Phone:904-763-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA94309225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist