Provider Demographics
NPI:1578610770
Name:CHAMPION THERAPY SERVICES
Entity Type:Organization
Organization Name:CHAMPION THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:CHAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC,SLP
Authorized Official - Phone:336-446-4206
Mailing Address - Street 1:501 BROWNBARK LN
Mailing Address - Street 2:
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27249-2761
Mailing Address - Country:US
Mailing Address - Phone:336-213-3352
Mailing Address - Fax:336-446-4206
Practice Address - Street 1:501 BROWNBARK LN
Practice Address - Street 2:
Practice Address - City:GIBSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27249-2761
Practice Address - Country:US
Practice Address - Phone:336-213-3352
Practice Address - Fax:336-446-4206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1782235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412405Medicaid
NC7211827Medicaid