Individual
SANDRA CHAMPLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1951 BLUEGRASS CIR, CHEYENNE, WY 82009-7355
(307) 773-8533
(307) 635-7578
Mailing address
1951 BLUEGRASS CIR, CHEYENNE, WY 82009-7355
(307) 773-8533
(307) 635-7578
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
250
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115862700
—
WY
01
—
310613
BC/BS
WY
01
—
650019472
RAILROAD MEDICARE
WY
Enumeration date
04/26/2006
Last updated
09/11/2015
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