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General NPI Number Information
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NPI Number | 1902393291
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Entity Type | Organization
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Legal Business Name | CHAMPION PHYSICAL THERAPY LLC HALLS
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 1125 EAST MORRIS BLVD.
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City | MORRISTOWN
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State | TN
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Zip | 37813
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Country | US
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Telephone | 423-714-0001
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Fax | 423-702-4940
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Provider Business Mailing Address
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Address Line | 1110 SHAWNEE RD
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City | LIMA
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State | OH
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Zip | 45805-3529
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Country | US
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Telephone | 419-221-6720
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Fax | 419-222-0507
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MR. BRAD C ROUSH
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Credential |
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Telephone | 419-221-6712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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