Healthcare Provider Details

I. General information

NPI: 1477151777
Provider Name (Legal Business Name): CHAMPION PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 SUGARFOOT WAY # 5
PIGEON FORGE TN
37863-6204
US

IV. Provider business mailing address

PO BOX 150
LIMA OH
45802-0150
US

V. Phone/Fax

Practice location:
  • Phone: 865-365-4800
  • Fax: 865-365-4801
Mailing address:
  • Phone: 419-221-6717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVE KRZYMINSKI
Title or Position: EXEC VP
Credential:
Phone: 419-221-6717