Individual
JENNIFER ROSE HAUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT, CIMT
Contact information
Practice address
7580 CHARLOTTE HWY, SUITE 1100, INDIAN LAND, SC 29707-7801
(803) 578-5662
(803) 548-5635
Mailing address
7580 CHARLOTTE HWY, SUITE 1100, INDIAN LAND, SC 29707-7801
(803) 578-5662
(803) 548-5635
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7440
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079KX
BCBS PROVIDER
NC
05
—
7211645
—
NC
01
—
7440
STATE LICENSE
NC
Enumeration date
10/24/2006
Last updated
04/23/2015
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