Basic Information
| Provider Information | |||||||||
| NPI: | 1396779419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAMPAGNE | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 148 EAST AVE | ||||||||
| Address2: | SUITE 3H | ||||||||
| City: | NORWALK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068515721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038665458 | ||||||||
| FaxNumber: | 2033546182 | ||||||||
| Practice Location | |||||||||
| Address1: | 162 MOUNTAIN RD | ||||||||
| Address2: | |||||||||
| City: | SUFFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060782091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606689589 | ||||||||
| FaxNumber: | 8606689802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 005143 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.