Provider Demographics
NPI:1023721149
Name:MITRA, ROCHELLE CALAYAG (DPT)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:CALAYAG
Last Name:MITRA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2152 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-3345
Mailing Address - Country:US
Mailing Address - Phone:224-858-5161
Mailing Address - Fax:847-515-4149
Practice Address - Street 1:2152 RANDALL RD
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110-3345
Practice Address - Country:US
Practice Address - Phone:248-858-5161
Practice Address - Fax:847-515-4149
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070027888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist