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General NPI Number Information
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NPI Number | 1154936201
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Entity Type | Individual
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Provider Name | CARSON SOCH PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 3140 FINLEY RD STE 400D
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1376
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Country | US
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Telephone | 331-775-2813
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Fax |
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Provider Business Mailing Address
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Address Line | 846 W FLETCHER ST APT J3
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City | CHICAGO
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State | IL
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Zip | 60657-4454
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Country | US
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Telephone | 224-406-5131
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.025554
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License Number State | IL
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