Provider Demographics
NPI:1437288842
Name:ROUSSEAU, ASHLEY B (ATC)
Entity Type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:B
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 ASH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-3774
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:279 ASH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3774
Practice Address - Country:US
Practice Address - Phone:603-289-3182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2009-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer