Provider Demographics
NPI:1063733590
Name:ROCHA, SUSAN GENOVEVA (PT)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:GENOVEVA
Last Name:ROCHA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N LOUIS ST
Mailing Address - Street 2:UNIT-E
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2579
Mailing Address - Country:US
Mailing Address - Phone:847-208-4244
Mailing Address - Fax:847-394-1858
Practice Address - Street 1:207 N LOUIS ST
Practice Address - Street 2:UNIT-E
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2579
Practice Address - Country:US
Practice Address - Phone:847-208-4244
Practice Address - Fax:847-394-1858
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-008104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist