Provider Demographics
NPI:1801770029
Name:RICE, CHARLES DEMETRIUS (MT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:DEMETRIUS
Last Name:RICE
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 VICKERS DR APT 327
Mailing Address - Street 2:
Mailing Address - City:COLO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8919
Mailing Address - Country:US
Mailing Address - Phone:719-464-8815
Mailing Address - Fax:
Practice Address - Street 1:304 S 8TH ST STE 103
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1829
Practice Address - Country:US
Practice Address - Phone:719-475-9103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0010621225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist