Provider Demographics
NPI:1255083176
Name:KERSHA, ROLA (DPT)
Entity type:Individual
Prefix:
First Name:ROLA
Middle Name:
Last Name:KERSHA
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 1:3524 STACKINGHAY DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8336
Mailing Address - Country:US
Mailing Address - Phone:248-496-9924
Mailing Address - Fax:
Practice Address - Street 1:8434 CORCORAN RD
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60480-1666
Practice Address - Country:US
Practice Address - Phone:708-467-0657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.026264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist