Healthcare Provider Details

I. General information

NPI: 1508360744
Provider Name (Legal Business Name): JONATHAN WILLIAM ROUSE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 GREENSPRING DR
TIMONIUM MD
21093-3112
US

IV. Provider business mailing address

5 PENNY LN
NEW FREEDOM PA
17349-9500
US

V. Phone/Fax

Practice location:
  • Phone: 410-512-5820
  • Fax:
Mailing address:
  • Phone: 717-659-7989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27657
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: