Provider Demographics
NPI:1861062804
Name:ROUSSEVA, MARIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:ROUSSEVA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12550 SOUTH FWY STE 106
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8438
Mailing Address - Country:US
Mailing Address - Phone:817-426-4401
Mailing Address - Fax:817-426-4410
Practice Address - Street 1:12550 SOUTH FWY STE 106
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8438
Practice Address - Country:US
Practice Address - Phone:817-426-4401
Practice Address - Fax:817-426-4410
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1346692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist