Provider Demographics
NPI:1154875615
Name:ROUSH, STACY (LMT)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:ROUSH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:STRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7434 KING RD
Mailing Address - Street 2:
Mailing Address - City:SARDINIA
Mailing Address - State:OH
Mailing Address - Zip Code:45171-8328
Mailing Address - Country:US
Mailing Address - Phone:937-515-1527
Mailing Address - Fax:
Practice Address - Street 1:7434 KING RD
Practice Address - Street 2:
Practice Address - City:SARDINIA
Practice Address - State:OH
Practice Address - Zip Code:45171-8328
Practice Address - Country:US
Practice Address - Phone:937-515-1527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.018104225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist