Provider Demographics
NPI:1518708924
Name:SANTA MARIA, CHARLEE
Entity type:Individual
Prefix:
First Name:CHARLEE
Middle Name:
Last Name:SANTA MARIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12227 78TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-4408
Mailing Address - Country:US
Mailing Address - Phone:206-432-2715
Mailing Address - Fax:
Practice Address - Street 1:27641 COVINGTON WAY SE STE 1
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-9120
Practice Address - Country:US
Practice Address - Phone:253-630-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61446555225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist