Provider Demographics
NPI:1558170597
Name:CHAMPION PHYSICAL THERAPY AND WELLNESS LLC
Entity type:Organization
Organization Name:CHAMPION PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:II
Authorized Official - Credentials:DPT
Authorized Official - Phone:254-640-1783
Mailing Address - Street 1:8051 N TAMIAMI TRL STE A1E6
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2032
Mailing Address - Country:US
Mailing Address - Phone:254-640-1783
Mailing Address - Fax:
Practice Address - Street 1:5351 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480-3416
Practice Address - Country:US
Practice Address - Phone:352-780-1561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy