MEDICARE: CHARLENE R CHALLENGER-SMITH PT

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	2251S0007X	Sports Physical Therapist	PTL.0016698	CO
2	225100000X	Physical Therapist	PTL.0016698	CO

General Provider Information

NPI Number	:	1316975493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE R CHALLENGER-SMITH PT

Provider Business Mailing Address
First Line	:	2001 MALLORY LN
Second Line	:	SUITE 201
City	:	FRANKLIN
State	:	TN
Zip	:	37067-8233
Country	:	US
Telephone Number	:	615-373-1358
Fax Number	:	615-221-9054

Provider Business Practice Location Address
First Line	:	210 25TH AVE N
Second Line	:	SUITE 520
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1606
Country	:	US
Telephone Number	:	615-321-3215
Fax Number	:	615-321-3216

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	01/24/2020

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