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General NPI Number Information
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NPI Number | 1457530149
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Entity Type | Organization
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Legal Business Name | CHAMPION PHYSICAL THERAPY AND FITNESS
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 65 E GARNER RD STE 100
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City | BROWNSBURG
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State | IN
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Zip | 46112-7867
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Country | US
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Telephone | 317-797-4797
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Fax |
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Provider Business Mailing Address
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Address Line | 496 COBBLESTONE PL
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City | AVON
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State | IN
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Zip | 46123-9422
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Country | US
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Telephone | 317-797-4797
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/SECRETARY
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Name | DOUGLAS P. WYNEKEN
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Credential | PT
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Telephone | 317-797-4797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 05006312A
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License Number State | IN
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