Champion Physical Therapy LLC Halls
Organization Active NPI Rehabilitation Clinic/Center · Harriman, TN
NPI 1922595388 · NPPES record last updated Apr 20, 2018
Key facts
- NPI
- 1922595388
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rehabilitation Clinic/Center 261QR0400X
- Legal business name
- CHAMPION PHYSICAL THERAPY LLC HALLS
- Practice address
- 2305 N Gateway Ave Unit 5
Harriman, TN 37748-8682 - Phone
- (865) 590-7084
- Fax
- (865) 591-7143
- NPI assigned
- Apr 20, 2018
- Organization subpart
- No
Authorized official
- Name
- Mr. Brad C Roush
- Title
- Executive Vice President
- Phone
- (419) 221-6712
Other NPIs on the same Medicare enrollment 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20181003001490 | TN | Part a Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services | 1355416306 |
3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Alcoa, TN; Athens, TN; Cleveland, TN |
National Provider Directory
Locations
2305 N Gateway Ave
Unit 5
Harriman, TN 37748
Phone (865) 590-7084
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Clinic/Center | 261QR0400X | Yes |
Addresses
Primary practice location
2305 N Gateway Ave Unit 5
Harriman, TN 37748-8682
Mailing address
1110 Shawnee Rd
Lima, OH 45805-3529
Phone (419) 221-6720
Other names
- CORA Physical Therapy - Harriman
Other providers in Harriman, TN
- Whitney Capshaw
- Ramona Carpenter
- Trisha Ann Carver
- Carlo Cereno
- Benjamin Michael Chalstrom
- Geri Marie Childs
- Cassandra Claborn
- Joshua David Clark-Fuqua
- Katlyn Bailey Clark-Fuqua
- Douglas Marley Clark
All providers in Harriman, TN · Rehabilitation Clinic/Center in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.