Provider Demographics
NPI:1164490439
Name:ROULEAU, PATRICIA ANNE (PT, OCS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:ROULEAU
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4518 HALLAM HILL LANE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1808
Mailing Address - Country:US
Mailing Address - Phone:863-644-0007
Mailing Address - Fax:863-644-3377
Practice Address - Street 1:4720 CLEVELAND HEIGHTS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2243
Practice Address - Country:US
Practice Address - Phone:863-644-0007
Practice Address - Fax:863-644-3377
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 10755225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9221OtherBC/BS NUMBER
FLY9221OtherBC/BS NUMBER