Healthcare Provider Details

I. General information

NPI: 1891484713
Provider Name (Legal Business Name): VALERIE JEAN ROUSE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8941 HARLAN ST
WESTMINSTER CO
80031-2931
US

IV. Provider business mailing address

9213 WELBY ROAD TER
THORNTON CO
80229-4290
US

V. Phone/Fax

Practice location:
  • Phone: 303-881-1830
  • Fax:
Mailing address:
  • Phone: 303-881-1830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number0002127
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: