Provider Demographics
NPI:1912165101
Name:ROUSH, REBECCA SALLEE (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SALLEE
Last Name:ROUSH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:SALLEE
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:812 S GARFIELD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3456
Mailing Address - Country:US
Mailing Address - Phone:231-709-0045
Mailing Address - Fax:231-421-9193
Practice Address - Street 1:812 S GARFIELD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3456
Practice Address - Country:US
Practice Address - Phone:231-709-0045
Practice Address - Fax:231-421-9193
Is Sole Proprietor?:No
Enumeration Date:2008-05-25
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP51620005Medicare UPIN