Provider Demographics
NPI:1437360427
Name:CH PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CH PHYSICAL THERAPY LLC
Other - Org Name:COLIN HOOBLER HOLDING LLC SOLEMBR
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOBLER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:971-244-9000
Mailing Address - Street 1:815 NW 13TH AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3022
Mailing Address - Country:US
Mailing Address - Phone:971-244-9000
Mailing Address - Fax:971-244-9005
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:971-244-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274553Medicaid
OR138914Medicare PIN