Provider Demographics
NPI:1023342896
Name:HECTOR, CHARLEEN M (CMT)
Entity type:Individual
Prefix:MS
First Name:CHARLEEN
Middle Name:M
Last Name:HECTOR
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:MRS
Other - First Name:CHARLEEN
Other - Middle Name:M
Other - Last Name:KIZAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMT
Mailing Address - Street 1:203 COOPER AVE N
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4446
Mailing Address - Country:US
Mailing Address - Phone:320-310-4000
Mailing Address - Fax:320-253-1575
Practice Address - Street 1:203 COOPER AVE N
Practice Address - Street 2:SUITE 160
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4446
Practice Address - Country:US
Practice Address - Phone:320-310-4000
Practice Address - Fax:320-253-1575
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist