Organization
CHAMPION FITNESS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFERY C SCHADE PHYSICAL THERAPIST (OWNER)
(815) 844-4742
Entity
Organization
Contact information
Practice address
924 W CUSTER AVE, PONTIAC, IL 61764-1067
(815) 844-5411
(815) 844-5318
Mailing address
924 W CUSTER AVE, PONTIAC, IL 61764-1067
(815) 844-4690
(815) 844-4810
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5307269
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/23/2006
Last updated
02/10/2025
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