Basic Information
| Provider Information | |||||||||
| NPI: | 1801330469 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DENEEN | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1205 W US HIGHWAY 30 | ||||||||
| Address2: | E | ||||||||
| City: | CARROLL | ||||||||
| State: | IA | ||||||||
| PostalCode: | 514013364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7127947939 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 303 E BASELINE RD STE 101 | ||||||||
| Address2: | 101 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850426561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022431476 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2016 | ||||||||
| LastUpdateDate: | 02/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 12681 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.