Provider Demographics
NPI:1225811342
Name:CHAMPION PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:CHAMPION PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINE
Authorized Official - Middle Name:KARTALIAN
Authorized Official - Last Name:ABRAHAMAINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:310-854-2618
Mailing Address - Street 1:3436 N VERDUGO RD STE 102
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1546
Mailing Address - Country:US
Mailing Address - Phone:310-854-9314
Mailing Address - Fax:
Practice Address - Street 1:3436 N VERDUGO RD STE 102
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1546
Practice Address - Country:US
Practice Address - Phone:310-854-9314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy