Provider Demographics
NPI:1447405444
Name:CHAMBERS, IVY TRINELL (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:IVY
Middle Name:TRINELL
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 E 154TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-4917
Mailing Address - Country:US
Mailing Address - Phone:216-295-9640
Mailing Address - Fax:
Practice Address - Street 1:3737 E 154TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-4917
Practice Address - Country:US
Practice Address - Phone:216-295-9640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-005503174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist