Organization
CHAMPION PHYSICAL THERAPY & ATHLETIC REHABILITATION, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN D LONG PT/ATC (PRESIDENT)
(402) 203-1872
Entity
Organization
Contact information
Practice address
10700 SAPP BROTHERS DR, OMAHA, NE 68138-3823
(402) 203-1872
Mailing address
10700 SAPP BROTHERS DR, OMAHA, NE 68138-3823
(402) 203-1872
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1906
NE
2255A2300X
Athletic Trainer
375
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02148
BLUE CROSS BLUE SHEILD
NE
05
—
10025424600
—
NE
Enumeration date
08/05/2006
Last updated
09/21/2007
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