Organization
CHAMPION PERFORMANCE PHYSICAL THERAPY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIE JEAN POWELL MSPT (OWNER, PHYSICAL THERAPIST)
(512) 996-0441
Entity
Organization
Contact information
Practice address
12611 HYMEADOW DR, AUSTIN, TX 78729-2700
(512) 996-0441
(512) 996-0442
Mailing address
PO BOX 170040, AUSTIN, TX 78717-0003
(512) 996-0441
(512) 996-0442
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
656610000
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0045MR
BC/BS PROVIDER NUMBER
TX
01
—
3418380
CIGNA
TX
01
—
7141718
AETNA
TX
Enumeration date
03/14/2006
Last updated
07/28/2010
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