Provider Demographics
NPI:1083192496
Name:CHAMPAGNE, RAYMOND J II (MED, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:J
Last Name:CHAMPAGNE
Suffix:II
Gender:M
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 FAITH CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827
Mailing Address - Country:US
Mailing Address - Phone:985-860-2876
Mailing Address - Fax:
Practice Address - Street 1:PENN STATE SPORTS MEDICINE
Practice Address - Street 2:109 LASCH BUILDING
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802
Practice Address - Country:US
Practice Address - Phone:985-860-2876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer