NPIMap

Organization Active NPI

Champion Physical Therapy LLC Halls

Doing business as CORA Physical Therapy - Johnson City

  • Rehabilitation Clinic/Center
  • Johnson City, TN
National Provider Identifier
1083101448
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
CHAMPION PHYSICAL THERAPY LLC HALLS
Doing business as
CORA Physical Therapy - Johnson City
Practice address
4307 N Roan St Ste 7
Johnson City, TN 37615-4973
Phone
(423) 491-5222
Fax
(423) 491-5223
NPI assigned
Apr 20, 2018
Last updated
Oct 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

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

Authorized official

Name
Steve Krzyminski
Title
Exec VP
Phone
(419) 221-6717

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

4307 N Roan St Ste 7
Johnson City, TN 37615-4973

Mailing address

PO Box 150
Lima, OH 45802-0150
Phone (419) 221-6717

Other names 1

  • CORA Physical Therapy - Johnson City Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180831000739 TN Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 1355416306 4 other NPIs on this enrollment
Practice locations: Bristol, TN; Kingsport, TN; Johnson City, TN; Elizabethton, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083101448. Details of each certification follow.

  • CCN 446723 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 446723

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CORA PHYSICAL THERAPY - JOHNSON CITY
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Dec 14, 2018
Last certification
Mar 10, 2025
Ownership / control type
Proprietary
Facility address
4307 N Roan St, Suite 7
Johnson City, TN 37615

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Champion Physical Therapy LLC Halls10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1524182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697068800000",
    "number": "1083101448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 150",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458020150",
            "telephone_number": "419-221-6717",
            "fax_number": "419-222-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4307 N ROAN ST STE 7",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154973",
            "telephone_number": "423-491-5222",
            "fax_number": "423-491-5223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPION PHYSICAL THERAPY LLC HALLS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-20",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A",
        "authorized_official_last_name": "KRZYMINSKI",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "EXEC VP",
        "authorized_official_telephone_number": "419-221-6717"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CORA Physical Therapy - Johnson City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.