Provider Demographics
NPI:1316362494
Name:CHAMPION REHABILITATION LLC
Entity Type:Organization
Organization Name:CHAMPION REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:609-677-7268
Mailing Address - Street 1:2500 ENGLISH CREEK AVE
Mailing Address - Street 2:LIFECENTER
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5549
Mailing Address - Country:US
Mailing Address - Phone:609-677-7268
Mailing Address - Fax:609-677-7269
Practice Address - Street 1:2500 ENGLISH CREEK AVE
Practice Address - Street 2:LIFECENTER
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5549
Practice Address - Country:US
Practice Address - Phone:609-677-7268
Practice Address - Fax:609-677-7269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00825800261QP2000X
NJ40QA01290500261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy