Provider Demographics
NPI:1871904334
Name:KATRAWALA, ROHMA
Entity type:Individual
Prefix:
First Name:ROHMA
Middle Name:
Last Name:KATRAWALA
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 1:561 S BREWSTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2409
Mailing Address - Country:US
Mailing Address - Phone:315-410-0641
Mailing Address - Fax:
Practice Address - Street 1:400 W BUTTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-4877
Practice Address - Country:US
Practice Address - Phone:630-832-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-17
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.019547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist