MEDICARE: LITTLE CHAMPIONS PEDIATRIC THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1588532584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE CHAMPIONS PEDIATRIC THERAPY, LLC

Provider Business Mailing Address
First Line	:	1430 KNOTTS HAVEN LOOP
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-7296
Country	:	US
Telephone Number	:	423-579-4484
Fax Number	:	423-579-4484

Provider Business Practice Location Address
First Line	:	1430 KNOTTS HAVEN LOOP
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-7296
Country	:	US
Telephone Number	:	423-579-4484
Fax Number	:	423-579-4484

Authorized Official
Title or Position	:	OWNER
Name	:	HILLARY ANNE PHILLIPS
Credential	:
Telephone Number	:	423-579-4484

Provider Enumeration Date	:	10/29/2025
Last Update Date	:	10/29/2025

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