Provider Demographics
NPI:1154936201
Name:SOCH, CARSON (PT, DPT)
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:
Last Name:SOCH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 W FLETCHER ST APT J3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4454
Mailing Address - Country:US
Mailing Address - Phone:224-406-5131
Mailing Address - Fax:
Practice Address - Street 1:3140 FINLEY RD STE 400D
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1376
Practice Address - Country:US
Practice Address - Phone:331-775-2813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.025554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty