Provider Demographics
NPI:1346248770
Name:ROUSE, BRIAN JOSEPH (MSPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOSEPH
Last Name:ROUSE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20098 ASHBROOK PL
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3393
Mailing Address - Country:US
Mailing Address - Phone:703-723-5225
Mailing Address - Fax:703-723-5595
Practice Address - Street 1:20098 ASHBROOK PL
Practice Address - Street 2:SUITE 190
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3393
Practice Address - Country:US
Practice Address - Phone:703-723-5225
Practice Address - Fax:703-723-5595
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist