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General NPI Number Information
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NPI Number | 1548541444
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Entity Type | Organization
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Legal Business Name | A. B. CHAMP CORP
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Dates
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Enumeration Date | 09/06/2011
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 9999 NE 2ND AVE STE 202
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2345
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Country | US
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Telephone | 305-751-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 9999 NE 2ND AVE STE 202
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2345
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Country | US
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Telephone | 305-751-0011
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LYONEL CHAMPAGNE
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Credential | OTR/L
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Telephone | 954-557-5651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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