Organization Active NPI

Champion Fitness, Inc

  • Physical Therapy Clinic/Center
  • Streator, IL
National Provider Identifier
1336535582
Registry record updated May 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
CHAMPION FITNESS, INC
Practice address
119 S Sterling St
Streator, IL 61364-3015
Phone
(815) 673-2348
Fax
(815) 673-2345
NPI assigned
Apr 14, 2015
Organization subpart
Yes
Parent organization
CHAMPION FITNESS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 15, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Cohlman
Title
Ceo
Phone
(815) 844-5411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

119 S Sterling St
Streator, IL 61364-3015

Mailing address

924 W Custer Ave
Pontiac, IL 61764-1067
Phone (815) 844-5411

National Provider Directory

National Provider Directory
Part of
Champion Fitness

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1428969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431648000000",
    "number": "1336535582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "924 W CUSTER AVE",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617641067",
            "telephone_number": "815-844-5411",
            "fax_number": "815-844-5322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 S STERLING ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613643015",
            "telephone_number": "815-673-2348",
            "fax_number": "815-673-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPION FITNESS, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHAMPION FITNESS, INC",
        "enumeration_date": "2015-04-14",
        "last_updated": "2015-05-15",
        "status": "A",
        "authorized_official_last_name": "COHLMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "815-844-5411"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Streator, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.