Organization
CHAMP THERAPY AND WELLNESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY HOGAN DPT, PT, MOT, OTR/L (OWNER)
(248) 921-7720
Entity
Organization
Contact information
Practice address
1817 DEER VIEW CT, HOWELL, MI 48843-8091
(248) 921-7720
Mailing address
1817 DEER VIEW CT, HOWELL, MI 48843-8091
(248) 921-7720
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356719504
PERSONAL NPI
MI
Enumeration date
01/04/2022
Last updated
01/24/2022
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