Provider Demographics
NPI:1063678886
Name:GOMEZ-OCHOA, ROSARIO (PT)
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:
Last Name:GOMEZ-OCHOA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 NORTH MAPLE STREET
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681
Mailing Address - Country:US
Mailing Address - Phone:864-757-9846
Mailing Address - Fax:864-757-9847
Practice Address - Street 1:203 NORTH MAPLE STREET STE10
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681
Practice Address - Country:US
Practice Address - Phone:864-757-9846
Practice Address - Fax:864-757-9847
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist