Provider Demographics
NPI:1215249990
Name:CHAMPAGNE, ANNMARIE (PT)
Entity type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:
Last Name:CHAMPAGNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 PHILIPS PKWY
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1849
Mailing Address - Country:US
Mailing Address - Phone:201-930-8700
Mailing Address - Fax:201-930-8730
Practice Address - Street 1:21 PHILIPS PKWY
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1849
Practice Address - Country:US
Practice Address - Phone:201-930-8700
Practice Address - Fax:201-930-8730
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01349500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist