Provider Demographics
NPI:1265148217
Name:CHAMPION PHYSICAL THERAPY
Entity type:Organization
Organization Name:CHAMPION PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT, DPT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:CALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:702-530-6329
Mailing Address - Street 1:1658 BOULDER CITY PKWY
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-1904
Mailing Address - Country:US
Mailing Address - Phone:702-530-6329
Mailing Address - Fax:702-952-5417
Practice Address - Street 1:1658 BOULDER CITY PKWY
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-1904
Practice Address - Country:US
Practice Address - Phone:702-530-6329
Practice Address - Fax:702-952-5417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty