Provider Demographics
NPI:1417925785
Name:ROULEAU, ROBERT PAUL (PT, OCS, FAAOMPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:ROULEAU
Suffix:
Gender:M
Credentials:PT, OCS, FAAOMPT
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 LN
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
FLPT108762251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY92222OtherBCBS
FLU4610YMedicare ID - Type UnspecifiedIND. PROVIDER NUMBER