Provider Demographics
NPI:1306653704
Name:ROUSE, TAMMY L (PT, MPH)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:ROUSE
Suffix:
Gender:F
Credentials:PT, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 LICKSKILLET RD
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-8160
Mailing Address - Country:US
Mailing Address - Phone:228-217-5089
Mailing Address - Fax:228-436-1586
Practice Address - Street 1:3400 LICKSKILLET RD
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-8160
Practice Address - Country:US
Practice Address - Phone:228-217-5089
Practice Address - Fax:228-436-1586
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist