Provider Demographics
NPI:1396859971
Name:KRUEGER, ROCHELLE LEE (PT)
Entity Type:Individual
Prefix:MS
First Name:ROCHELLE
Middle Name:LEE
Last Name:KRUEGER
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 1:2022 W MELROSE ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6333
Mailing Address - Country:US
Mailing Address - Phone:773-251-3564
Mailing Address - Fax:
Practice Address - Street 1:2022 W MELROSE ST APT 2F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6333
Practice Address - Country:US
Practice Address - Phone:773-251-3564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636141OtherBLUE SHIELD PROVIDER NUMB
ILQ34H41OtherORTHO NET PROVIDER NUMBER