Provider Demographics
NPI:1427493105
Name:ROUSE, QUANTRAE
Entity type:Individual
Prefix:
First Name:QUANTRAE
Middle Name:
Last Name:ROUSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 S GEORGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-5847
Mailing Address - Country:US
Mailing Address - Phone:863-386-6040
Mailing Address - Fax:863-385-3245
Practice Address - Street 1:7205 S GEORGE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33875-5847
Practice Address - Country:US
Practice Address - Phone:863-382-7230
Practice Address - Fax:863-382-3245
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator