SHANE CHAMPION

GRAND BAY, AL
NPI1497033187
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: MS  PTA3404)
Enumeration Date2011-07-28
Last Update Date2011-07-28
Business Address
-- SHANE CHAMPION
5500 DARA LN
GRAND BAY, AL 36541-3465
Phone number: 251-454-1897
Mailing Address
-- SHANE CHAMPION
5500 DARA LN
GRAND BAY, AL 36541-3465
Phone number: