Provider Demographics
NPI:1356868293
Name:ROUSE, JOEL CAMERON (MA 60713373)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:CAMERON
Last Name:ROUSE
Suffix:
Gender:M
Credentials:MA 60713373
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8830 TALLON LN NE # H1
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-6656
Mailing Address - Country:US
Mailing Address - Phone:509-953-4356
Mailing Address - Fax:
Practice Address - Street 1:8830 TALLON LN NE # H1
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-6656
Practice Address - Country:US
Practice Address - Phone:971-319-5854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60713373225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist