Provider Demographics
NPI:1528449444
Name:ROUSE, TIARRA L (PT)
Entity type:Individual
Prefix:
First Name:TIARRA
Middle Name:L
Last Name:ROUSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TIARRA
Other - Middle Name:L
Other - Last Name:CACY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:620 E 25TH ST STE 7
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-5529
Mailing Address - Country:US
Mailing Address - Phone:308-455-1781
Mailing Address - Fax:308-455-1782
Practice Address - Street 1:620 E 25TH ST STE 7
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-5529
Practice Address - Country:US
Practice Address - Phone:308-455-1781
Practice Address - Fax:308-455-1782
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE$$$$$$$$$00Medicaid