Provider Demographics
NPI:1588302558
Name:CONCUSSION CHAMPIONS REHABILITATION LLC
Entity type:Organization
Organization Name:CONCUSSION CHAMPIONS REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KRISTYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-655-4362
Mailing Address - Street 1:328 MULBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-3406
Mailing Address - Country:US
Mailing Address - Phone:724-542-5441
Mailing Address - Fax:
Practice Address - Street 1:633 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1846
Practice Address - Country:US
Practice Address - Phone:724-542-5441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT019800OtherSTATE LICENSE