NPIMap

Organization Active NPI

Champion Rehabilitation

  • Physical Therapist
  • San Diego, CA
National Provider Identifier
1073613527
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT14065 Issued in CA
Legal business name
CHAMPION REHABILITATION
Practice address
2918 5TH Ave
Suite 101
San Diego, CA 92103-5910
Phone
(619) 497-1890
Fax
(619) 497-1857
NPI assigned
Sep 25, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Kevin Dee Tollefson, PHYSICAL THERAPISTNPI 1033200274
Title
Owner
Phone
(619) 497-1890

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X PT14065 CA Primary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X PT10276 CA

Addresses

Primary practice location

2918 5TH Ave
Suite 101
San Diego, CA 92103-5910

Mailing address

2918 5TH Ave
Suite 101
San Diego, CA 92103-5910
Phone (619) 497-1890

National Provider Directory

National Provider Directory

Locations

2918 5th Ave
Ste 101
San Diego, CA 92103
Phone (619) 497-1890

Practitioners & affiliated clinicians

Practitioners 2

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": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073613527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2918 5TH AVE",
            "address_2": "SUITE 101",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921035910",
            "telephone_number": "619-497-1890",
            "fax_number": "619-497-1857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2918 5TH AVE",
            "address_2": "SUITE 101",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921035910",
            "telephone_number": "619-497-1890",
            "fax_number": "619-497-1857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPION REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TOLLEFSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "DEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-497-1890",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHYSICAL THERAPIST"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT14065",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT10276",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.