Provider Demographics
NPI:1639203334
Name:CHAMP, ANN-MARIE D (PT)
Entity Type:Individual
Prefix:
First Name:ANN-MARIE
Middle Name:D
Last Name:CHAMP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4509
Mailing Address - Country:US
Mailing Address - Phone:410-277-8884
Mailing Address - Fax:
Practice Address - Street 1:3104 LORD BALTIMORE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2898
Practice Address - Country:US
Practice Address - Phone:410-298-0990
Practice Address - Fax:410-298-0871
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17649225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist