Healthcare Provider Details

I. General information

NPI: 1346248770
Provider Name (Legal Business Name): BRIAN JOSEPH ROUSE MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20098 ASHBROOK PL SUITE 190
ASHBURN VA
20147-3393
US

IV. Provider business mailing address

20098 ASHBROOK PL SUITE 190
ASHBURN VA
20147-3393
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-5225
  • Fax: 703-723-5595
Mailing address:
  • Phone: 703-723-5225
  • Fax: 703-723-5595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305203997
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: