Provider Demographics
NPI:1265554521
Name:GONCHER, ROSE ANNA (PTA)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:ANNA
Last Name:GONCHER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5061 VENITA DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-8963
Mailing Address - Country:US
Mailing Address - Phone:574-936-5885
Mailing Address - Fax:574-935-5886
Practice Address - Street 1:5061 VENITA DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-8963
Practice Address - Country:US
Practice Address - Phone:574-936-5885
Practice Address - Fax:574-935-5886
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001803A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant