Provider Demographics
NPI:1922570688
Name:ROUSE, CHRISTY LYNN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:LYNN
Last Name:ROUSE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:LOFTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:180 CHERRYFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9095
Mailing Address - Country:US
Mailing Address - Phone:912-308-8029
Mailing Address - Fax:912-335-6572
Practice Address - Street 1:5102 PAULSEN ST BLDG 7
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4624
Practice Address - Country:US
Practice Address - Phone:912-655-8855
Practice Address - Fax:912-335-6572
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT003293225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist