Provider Demographics
NPI:1306173323
Name:ROHILLA, SUCHETA
Entity type:Individual
Prefix:
First Name:SUCHETA
Middle Name:
Last Name:ROHILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 BRIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8019
Mailing Address - Country:US
Mailing Address - Phone:515-661-2098
Mailing Address - Fax:
Practice Address - Street 1:176 BRIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8019
Practice Address - Country:US
Practice Address - Phone:515-661-2098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist