Provider Demographics
NPI:1528624517
Name:ENGLEHART, CHARITY D (LMT)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:D
Last Name:ENGLEHART
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:D
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16010 SENECA TRL S
Mailing Address - Street 2:
Mailing Address - City:LINDSIDE
Mailing Address - State:WV
Mailing Address - Zip Code:24951-7260
Mailing Address - Country:US
Mailing Address - Phone:304-832-6441
Mailing Address - Fax:
Practice Address - Street 1:16010 SENECA TRL S
Practice Address - Street 2:
Practice Address - City:LINDSIDE
Practice Address - State:WV
Practice Address - Zip Code:24951-7260
Practice Address - Country:US
Practice Address - Phone:304-832-6441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2017-3526225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty