Individual
MS. MARLENE A. CHAMPAGNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4802 10TH AVE, BROOKLYN, NY 11219-2916
(718) 283-7498
Mailing address
15007 108TH AVE, JAMAICA, NY 11433-1909
(718) 291-4203
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
011775
NY
Other
Enumeration date
08/09/2007
Last updated
08/09/2007
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