Provider Demographics
NPI:1043617038
Name:ROUS, KIRSTEN ARIANA (ATC)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:ARIANA
Last Name:ROUS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 LAKEVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1566
Mailing Address - Country:US
Mailing Address - Phone:847-932-2025
Mailing Address - Fax:847-932-2054
Practice Address - Street 1:145 LAKEVIEW PKWY
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1566
Practice Address - Country:US
Practice Address - Phone:847-932-2025
Practice Address - Fax:847-932-2054
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960010262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer