NPIMap

Organization Active NPI

Champion Physical Therapy LLC

  • Physical Therapist
  • Cumming, GA
National Provider Identifier
1053509299
Registry record updated Oct 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
CHAMPION PHYSICAL THERAPY LLC
Practice address
540 Lake Center Pkwy
Suiet 107
Cumming, GA 30040-7727
Phone
(770) 205-3939
Fax
(770) 205-4994
NPI assigned
Oct 12, 2007
Last updated
Oct 12, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Matthew Lee Foltz, MPTNPI 1295813269
Title
Owner/Physical Therapist
Phone
(770) 205-3939

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

540 Lake Center Pkwy
Suiet 107
Cumming, GA 30040-7727

Mailing address

540 Lake Center Pkwy
Suiet 107
Cumming, GA 30040-7727
Phone (770) 205-3939

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071205000193 GA Part B Supplier - Clinic/Group Practice 6800985417 Receives reassigned benefits from 9 practitioners
Practice locations: Alpharetta, GA; Cumming, GA

National Provider Directory

National Provider Directory

Locations

5530 Windward Pkwy
Ste 325
Alpharetta, GA 30004
Phone (770) 410-1808

5530 Windward Pkwy
Ste 350
Alpharetta, GA 30004
Phone (770) 410-1808

540 Lake Center Pkwy
Ste 107
Cumming, GA 30040
Phone (770) 205-3939

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192147200000",
    "number": "1053509299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 LAKE CENTER PKWY",
            "address_2": "SUIET 107",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300407727",
            "telephone_number": "770-205-3939",
            "fax_number": "770-205-4994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 LAKE CENTER PKWY",
            "address_2": "SUIET 107",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300407727",
            "telephone_number": "770-205-3939",
            "fax_number": "770-205-4994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPION PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-12",
        "last_updated": "2007-10-12",
        "status": "A",
        "authorized_official_last_name": "FOLTZ",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "770-205-3939",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.