Organization
CHAMPION SPORTS MEDICINE AND PHYSICAL THERAPY, LLC
Active
Other names
Elevate Physical Therapy and Coaching, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
STUART ANTHONY WILSON PT (OWNER)
(720) 295-6098
Entity
Organization
Contact information
Practice address
1169 S ALKIRE ST, LAKEWOOD, CO 80228-3113
(720) 295-6098
Mailing address
1169 S ALKIRE ST, LAKEWOOD, CO 80228-3113
(720) 295-6098
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
7018
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
452611370
ANTHEM BCBS
CO
Enumeration date
05/04/2006
Last updated
10/22/2020
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