Provider Demographics
NPI:1033275441
Name:ROUSE, ANESHA AMOR
Entity Type:Individual
Prefix:MISS
First Name:ANESHA
Middle Name:AMOR
Last Name:ROUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27348 PARKVIEW BLVD
Mailing Address - Street 2:APT 5319
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2830
Mailing Address - Country:US
Mailing Address - Phone:586-558-3967
Mailing Address - Fax:
Practice Address - Street 1:7633 E. JEFFERSON AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214
Practice Address - Country:US
Practice Address - Phone:313-499-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant