Provider Demographics
NPI:1699214338
Name:HOERR, ROSE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:HOERR
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 1:2619 W HEADING AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:WEST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-4971
Mailing Address - Country:US
Mailing Address - Phone:855-476-5837
Mailing Address - Fax:
Practice Address - Street 1:3525 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-1324
Practice Address - Country:US
Practice Address - Phone:855-476-5837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070022803OtherPHYSICAL THERAPIST LICENSE NUMBER