Provider Demographics
NPI:1518432186
Name:ROUSSEAU, REBECCA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 SHEA ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-4889
Mailing Address - Country:US
Mailing Address - Phone:978-870-5271
Mailing Address - Fax:
Practice Address - Street 1:3455 REWAK DR
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5024
Practice Address - Country:US
Practice Address - Phone:907-457-5322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK136516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist