Provider Demographics
NPI:1235495854
Name:ROUSH, JASON CURRY (DPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:CURRY
Last Name:ROUSH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 HARGROVE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-6336
Mailing Address - Country:US
Mailing Address - Phone:303-579-7979
Mailing Address - Fax:
Practice Address - Street 1:91 HARGROVE CIRCLE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25403-6336
Practice Address - Country:US
Practice Address - Phone:303-579-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002568225100000X
MD24008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist