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General NPI Number Information
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NPI Number | 1144481375
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Entity Type | Organization
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Legal Business Name | CHAMPIONSHIP PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 06/20/2008
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Last Update Date | 11/07/2008
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Provider Practice Location Address
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Address Line | 314 E 1ST ST
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-2927
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Country | US
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Telephone | 315-439-8840
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Fax |
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Provider Business Mailing Address
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Address Line | 4567 CROSSROADS PARK DR
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City | LIVERPOOL
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State | NY
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Zip | 13088-3589
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Country | US
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Telephone | 315-295-2100
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | BRADLEY R PIKE
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Credential | PT
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Telephone | 315-439-8840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 014305
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License Number State | NY
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