Champion Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

CHAMPION PHYSICAL THERAPY LLC

Practice address

1175 W Wickenburg Way Ste 3
Wickenburg, AZ 85390-2262

Phone

(928) 668-0108

Fax

(928) 668-0110

NPI assigned

Nov 1, 2007

Organization subpart

No

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

Authorized official

Name

Janell Marie Flamand, PTNPI 1235405093

Title

Owner

Phone

(928) 668-0108

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Janell Marie Flamand, PT

  • Physical Therapist
  • Wickenburg, AZ
  • NPI 1235405093
  Medicare reassignment Care Compare group NPD Authorized official
• Edward R Flamand, PT

  • Physical Therapist
  • Wickenburg, AZ
  • NPI 1477829174
  Medicare reassignment Care Compare group NPD
• Michaela Goering, DPT

  • Physical Therapist
  • Wickenburg, AZ
  • NPI 1073171245
  Medicare reassignment Care Compare group NPD
• Tara Renae Littell, PT, DPT

  • Physical Therapist
  • Wickenburg, AZ
  • NPI 1225240435
  Medicare reassignment Care Compare group NPD
• Clay Mitchell, PTA

  • Physical Therapy Assistant
  • Wickenburg, AZ
  • NPI 1902685126
  NPD
• Tyler Dean Smith, DPT

  • Orthopedic Physical Therapist
  • Hurricane, UT
  • NPI 1548495310
  NPD (past)

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

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632355200000",
    "number": "1487833893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 W WICKENBURG WAY STE 3",
            "city": "WICKENBURG",
            "state": "AZ",
            "postal_code": "853902262",
            "telephone_number": "928-668-0108",
            "fax_number": "928-668-0110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 W WICKENBURG WAY STE 3",
            "city": "WICKENBURG",
            "state": "AZ",
            "postal_code": "853902262",
            "telephone_number": "928-668-0108",
            "fax_number": "928-668-0110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPION PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-01",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A",
        "authorized_official_last_name": "FLAMAND",
        "authorized_official_first_name": "JANELL",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-668-0108",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "461893",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DN7909",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Z118851",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane R Breneman, LPC
• Rita Marie Butler, MC, LPC, LISAC
• Mikaila Renae Caraveo Ruiz, PTA
• Syreeta Shawnta Carter, FNP
• Kenneth B Caton, P.A.
• John Chondropoulos
• Melissa Susanne Christmas, DNP, APRN-RNP
• Ronni C Chrzanowski, MD
• Laura L Churchill, MC, LPC
• Winnifred D Clark

• Physical Therapy Clinic/Center in Wickenburg, AZ
• Providers in Wickenburg, AZ by specialty
• Physical Therapy Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; 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.