Provider Demographics
NPI:1871580431
Name:ROUSE, TAWNYA LEANN (PT)
Entity type:Individual
Prefix:MS
First Name:TAWNYA
Middle Name:LEANN
Last Name:ROUSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-5207
Mailing Address - Country:US
Mailing Address - Phone:580-225-0848
Mailing Address - Fax:580-225-0873
Practice Address - Street 1:717 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5207
Practice Address - Country:US
Practice Address - Phone:580-225-0848
Practice Address - Fax:580-225-0873
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT3001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist