Provider Demographics
NPI:1528555992
Name:CHAMPION PHYSICAL THERAPY LLC HALLS
Entity Type:Organization
Organization Name:CHAMPION PHYSICAL THERAPY LLC HALLS
Other - Org Name:CORA PHYSICAL THERAPY - KINGSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC VP
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRZYMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-221-6717
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-0150
Mailing Address - Country:US
Mailing Address - Phone:419-221-6717
Mailing Address - Fax:419-222-0507
Practice Address - Street 1:1732 N EASTMAN RD STE 1A
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2376
Practice Address - Country:US
Practice Address - Phone:423-390-8948
Practice Address - Fax:423-390-8949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation