MEDICARE: CHAMPION PHYSICAL THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1225811342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAMPION PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	3436 N VERDUGO RD STE 102
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1546
Country	:	US
Telephone Number	:	310-854-9314
Fax Number	:

Provider Business Practice Location Address
First Line	:	3436 N VERDUGO RD STE 102
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1546
Country	:	US
Telephone Number	:	310-854-9314
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. MELINE KARTALIAN ABRAHAMAINS
Credential	:	DPT
Telephone Number	:	310-854-2618

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	08/14/2023

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