Basic Information
| Provider Information | |||||||||
| NPI: | 1437360427 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CH PHYSICAL THERAPY LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COLIN HOOBLER HOLDING LLC SOLEMBR | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 NW 13TH AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972093022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712449000 | ||||||||
| FaxNumber: | 9712449005 | ||||||||
| Practice Location | |||||||||
| Address1: | 914 NW 13TH AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972093039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712449000 | ||||||||
| FaxNumber: | 9712449005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 10/11/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HOOBLER | ||||||||
| AuthorizedOfficialFirstName: | COLIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9712449000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MPT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 274553 | 05 | OR | MEDICAID |