Healthcare Provider Details

I. General information

NPI: 1871580431
Provider Name (Legal Business Name): TAWNYA LEANN ROUSE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 W 3RD ST
ELK CITY OK
73644-5207
US

IV. Provider business mailing address

717 W 3RD ST
ELK CITY OK
73644-5207
US

V. Phone/Fax

Practice location:
  • Phone: 580-225-0848
  • Fax: 580-225-0873
Mailing address:
  • Phone: 580-225-0848
  • Fax: 580-225-0873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3001
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: