Provider Demographics
NPI:1962693093
Name:LUNA, ROCHELLE
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:LUNA
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 1:2319 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-1351
Mailing Address - Country:US
Mailing Address - Phone:956-740-5114
Mailing Address - Fax:
Practice Address - Street 1:1505 CALLE DEL NORTE STE 440
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6040
Practice Address - Country:US
Practice Address - Phone:956-722-6221
Practice Address - Fax:956-722-6275
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1287880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1287880OtherTEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS