Provider Demographics
NPI:1073771564
Name:CHAMPION PHYSICAL THERAPY LLC HALLS
Entity Type:Organization
Organization Name:CHAMPION PHYSICAL THERAPY LLC HALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-221-6712
Mailing Address - Street 1:1110 SHAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-3529
Mailing Address - Country:US
Mailing Address - Phone:419-221-6717
Mailing Address - Fax:419-222-0507
Practice Address - Street 1:7228 NORRIS FWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-5744
Practice Address - Country:US
Practice Address - Phone:865-300-0512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1316434764OtherNPI
TN1013404516OtherNPI
TN1528555992OtherNPI
TN1558858902OtherNPI
TN1396232682OtherNPI
TN1902393291OtherNPI
TN3650169OtherMEDICARE PART B
TN1083101448OtherNPI
TN1083101463OtherNPI
TN1841787207OtherNPI
TN1013404409OtherNPI
TN1285121673OtherNPI
TN1396232781OtherNPI
TN1922595388OtherNPI