NPIMap

Organization Active NPI

Champion Physical Therapy Kentucky, LLC

  • Rehabilitation Clinic/Center
  • Somerset, KY
National Provider Identifier
1689150682
Registry record updated Oct 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
CHAMPION PHYSICAL THERAPY KENTUCKY, LLC
Practice address
2835 S Highway 27 Ste 286B
Somerset, KY 42501-3062
Phone
(606) 302-2831
Fax
(606) 687-3152
NPI assigned
Jul 13, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2023

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

Authorized official

Name
Mr. Stephen R Krzyminski
Title
Executive Vice President
Phone
(419) 221-6717

Specialties & licenses 1

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

Addresses

Primary practice location

2835 S Highway 27 Ste 286B
Somerset, KY 42501-3062

Mailing address

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

Other names 1

  • CORA Physical Therapy - Somerset Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190520000641 KY Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 3476818519 Practice locations: Somerset, KY

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Champion Physical Therapy Kentucky LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

14889 N US Highway 25 E
Ste 9
Corbin, KY 40701
Phone (606) 202-7014

Practitioners & affiliated clinicians

Practitioners 43

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

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1531440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1689150682",
    "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": "2835 S HIGHWAY 27 STE 286B",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425013062",
            "telephone_number": "606-302-2831",
            "fax_number": "606-687-3152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPION PHYSICAL THERAPY KENTUCKY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-13",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "KRZYMINSKI",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "419-221-6717",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "KY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CORA Physical Therapy - Somerset",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Somerset, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; 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.