Provider Demographics
NPI:1063165850
Name:CHAMPION PHYSICAL THERAPY AND REHAB SERVICES LLC
Entity type:Organization
Organization Name:CHAMPION PHYSICAL THERAPY AND REHAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-649-2528
Mailing Address - Street 1:6582 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:BURTCHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48059-2006
Mailing Address - Country:US
Mailing Address - Phone:810-334-1127
Mailing Address - Fax:231-346-5937
Practice Address - Street 1:87 N HOWARD AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:CROSWELL
Practice Address - State:MI
Practice Address - Zip Code:48422-1200
Practice Address - Country:US
Practice Address - Phone:810-334-1127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty