Basic Information
| Provider Information | |||||||||
| NPI: | 1598786501 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROCHELLE | ||||||||
| FirstName: | BEVERLY | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5962 LA PLACE CT | ||||||||
| Address2: | STE 170 | ||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920088807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009294776 | ||||||||
| FaxNumber: | 7609318370 | ||||||||
| Practice Location | |||||||||
| Address1: | 2115 MONTIEL RD | ||||||||
| Address2: | #103 | ||||||||
| City: | SAN MARCOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920693587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607388190 | ||||||||
| FaxNumber: | 7607386001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 8106 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.