Provider Demographics
NPI:1760612915
Name:CHAMPION, JAMIE BRENDA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:BRENDA
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 E. THOUSAND OAKS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362
Mailing Address - Country:US
Mailing Address - Phone:805-494-3131
Mailing Address - Fax:805-494-3002
Practice Address - Street 1:3625 E. THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:805-494-3131
Practice Address - Fax:805-494-3002
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist