Provider Demographics
NPI:1518092444
Name:CHAMPO, ANNETTE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:CHAMPO
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 E GREEN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2900
Mailing Address - Country:US
Mailing Address - Phone:626-744-1501
Mailing Address - Fax:
Practice Address - Street 1:936 E GREEN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2900
Practice Address - Country:US
Practice Address - Phone:626-744-1501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist