Provider Demographics
NPI:1730793233
Name:ROUSE, LORI (LMT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ROUSE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 PISA DR APT 11213
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-2193
Mailing Address - Country:US
Mailing Address - Phone:317-985-1060
Mailing Address - Fax:
Practice Address - Street 1:8625 PISA DR APT 11213
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-2193
Practice Address - Country:US
Practice Address - Phone:317-985-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA90452225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist