Organization
CHAMPION PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANELL MARIE FLAMAND PT (OWNER)
(928) 668-0108
Entity
Organization
Contact information
Practice address
1175 W WICKENBURG WAY STE 3, WICKENBURG, AZ 85390-2262
(928) 668-0108
(928) 668-0110
Mailing address
1175 W WICKENBURG WAY STE 3, WICKENBURG, AZ 85390-2262
(928) 668-0108
(928) 668-0110
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
461893
—
AZ
01
—
DN7909
RAILROAD MEDICARE
AZ
01
—
Z118851
MEDICARE
AZ
Enumeration date
11/01/2007
Last updated
09/23/2021
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