Healthcare Provider Details

I. General information

NPI: 1447068036
Provider Name (Legal Business Name): KOAH HEALTH PHYSICAL THERAPY & FUNCTIONAL MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2024
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 MAIN ST STE B
HUNTINGTON BEACH CA
92648-8124
US

IV. Provider business mailing address

218 FRANKFORT AVE
HUNTINGTON BEACH CA
92648-4928
US

V. Phone/Fax

Practice location:
  • Phone: 657-837-0335
  • Fax:
Mailing address:
  • Phone: 323-232-9680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MELANIE CHERNEY
Title or Position: OWNER/DOCTOR OF PHYSICAL THERAPY
Credential: PT
Phone: 323-232-9680