Provider Demographics
NPI:1316287980
Name:HARBERT, ROCHELLE
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:HARBERT
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 1:5124 WISTFUL VISTA DR
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-6924
Mailing Address - Country:US
Mailing Address - Phone:515-441-1281
Mailing Address - Fax:
Practice Address - Street 1:5124 WISTFUL VISTA DR
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-6924
Practice Address - Country:US
Practice Address - Phone:515-441-1281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036098225100000X
IA091223225100000X
CT010499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist