Provider Demographics
NPI:1780962472
Name:ROUSSE, WENDY MICHELLE (PT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:MICHELLE
Last Name:ROUSSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:MICHELLE
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:62 BROWN BEAR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7672
Mailing Address - Country:US
Mailing Address - Phone:919-274-1114
Mailing Address - Fax:
Practice Address - Street 1:5705 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5318
Practice Address - Country:US
Practice Address - Phone:919-401-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist