Individual
SHANE CHAMPION
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5500 DARA LN, GRAND BAY, AL 36541-3465
(251) 454-1897
Mailing address
5500 DARA LN, GRAND BAY, AL 36541-3465
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA3404
MS
Other
Enumeration date
07/28/2011
Last updated
07/28/2011
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