Healthcare Provider Details

I. General information

NPI: 1548541444
Provider Name (Legal Business Name): A. B. CHAMP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9999 NE 2ND AVE STE 202
MIAMI SHORES FL
33138-2345
US

IV. Provider business mailing address

9999 NE 2ND AVE STE 202
MIAMI SHORES FL
33138-2345
US

V. Phone/Fax

Practice location:
  • Phone: 305-751-0011
  • Fax:
Mailing address:
  • Phone: 305-751-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LYONEL CHAMPAGNE
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 954-557-5651