Basic Information
| Provider Information | |||||||||
| NPI: | 1508360744 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROUSE | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 PENNY LN | ||||||||
| Address2: | |||||||||
| City: | NEW FREEDOM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173499500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176597989 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2118 GREENSPRING DR | ||||||||
| Address2: | |||||||||
| City: | TIMONIUM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210933112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105125820 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2018 | ||||||||
| LastUpdateDate: | 06/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MD | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.