Provider Demographics
NPI:1588063986
Name:CHAMPION SPORTS MEDICINE
Entity type:Organization
Organization Name:CHAMPION SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:POIRIER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:734-625-2921
Mailing Address - Street 1:700 SUMMIT PL
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3014 ALLISON BONNETT MEMORIAL DR STE 144
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-2394
Practice Address - Country:US
Practice Address - Phone:205-744-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSIOTHERAPY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7300261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy