Provider Demographics
NPI:1104019009
Name:CHC PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:CHC PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'MALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:440-356-3213
Mailing Address - Street 1:20370 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126
Mailing Address - Country:US
Mailing Address - Phone:440-356-3213
Mailing Address - Fax:440-331-0453
Practice Address - Street 1:20370 LORAIN RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126
Practice Address - Country:US
Practice Address - Phone:440-356-3213
Practice Address - Fax:440-331-0453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2022-07-21
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
OH0814172Medicare PIN