Healthcare Provider Details

I. General information

NPI: 1760683346
Provider Name (Legal Business Name): BOARD OF DIRECTORS OF THE ROUSE ESTATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 ROUSE AVE
YOUNGSVILLE PA
16371-1605
US

IV. Provider business mailing address

701 ROUSE AVE
YOUNGSVILLE PA
16371-1605
US

V. Phone/Fax

Practice location:
  • Phone: 814-563-6412
  • Fax:
Mailing address:
  • Phone: 814-563-7565
  • Fax: 814-563-9409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SONIA M PROBST
Title or Position: CEO
Credential:
Phone: 814-563-6408