Provider Demographics
NPI:1255318945
Name:TRCHKA, SUSAN ELIZABETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:TRCHKA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:RADDATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-0300
Mailing Address - Country:US
Mailing Address - Phone:888-201-1040
Mailing Address - Fax:866-245-8064
Practice Address - Street 1:119 E OGDEN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3590
Practice Address - Country:US
Practice Address - Phone:630-325-2664
Practice Address - Fax:866-245-8064
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070003221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00832125OtherRAILROAD MEDICARE
ILIL1582002Medicare PIN