Provider Demographics
NPI:1750689790
Name:ROUSE, WILLIAM THOMAS (HIS)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:ROUSE
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 HALSTEAD BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-7036
Mailing Address - Country:US
Mailing Address - Phone:252-337-7500
Mailing Address - Fax:252-337-7400
Practice Address - Street 1:1294 PROFESSIONAL DR STE C
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5753
Practice Address - Country:US
Practice Address - Phone:843-213-0099
Practice Address - Fax:843-213-0200
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHAS-0620237700000X
NC1324237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist