Provider Demographics
NPI:1417527466
Name:CHAMPION, THOMAS J (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:CHAMPION
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 HAHNS PEAK DR UNIT 202
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-6013
Mailing Address - Country:US
Mailing Address - Phone:775-671-2855
Mailing Address - Fax:
Practice Address - Street 1:107 W 29TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2200
Practice Address - Country:US
Practice Address - Phone:970-663-6142
Practice Address - Fax:970-635-3087
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17740OtherPT LICENSE