Provider Demographics
NPI:1326040270
Name:ROUSE, DAWN ANGELA (PT)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:ANGELA
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 1:77 MEADOW VIEW RD
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-3072
Mailing Address - Country:US
Mailing Address - Phone:828-399-0402
Mailing Address - Fax:888-511-1844
Practice Address - Street 1:59 OAKDALE ST
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3951
Practice Address - Country:US
Practice Address - Phone:828-966-9036
Practice Address - Fax:828-966-4538
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8844225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211670Medicaid
NC2500236AMedicare ID - Type Unspecified