Provider Demographics
NPI:1518331891
Name:CROUSE, RORY (LAC)
Entity Type:Individual
Prefix:
First Name:RORY
Middle Name:
Last Name:CROUSE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477
Mailing Address - Country:US
Mailing Address - Phone:631-404-7073
Mailing Address - Fax:631-751-8298
Practice Address - Street 1:134 BURT ST
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477
Practice Address - Country:US
Practice Address - Phone:645-663-5924
Practice Address - Fax:631-751-8298
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005658171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist