Provider Demographics
NPI:1033149281
Name:CH PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CH PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOBLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-244-6000
Mailing Address - Street 1:PO BOX 42510
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97242-0510
Mailing Address - Country:US
Mailing Address - Phone:503-963-1294
Mailing Address - Fax:503-230-1541
Practice Address - Street 1:914 NW 13TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3039
Practice Address - Country:US
Practice Address - Phone:971-244-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
840342000OtherBLUE CROSS
R131444Medicare ID - Type Unspecified