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1780210062
ANDREW JACOB ROUSH
PROVO, UT
NPI
1780210062
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: UT 2000038169)
Enumeration Date
2020-03-18
Last Update Date
2020-03-18
Business Address
ANDREW JACOB ROUSH
226 E 400 N
PROVO, UT 84606-2914
Phone number: 801-725-8522
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Mailing Address
ANDREW JACOB ROUSH
226E 400 NORTH
PROVO, UT 84606
Phone number:
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