Provider Demographics
NPI:1790094621
Name:ROUX, ALLISON R (PT)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:R
Last Name:ROUX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:ROME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1578 ELDERBERRY LOOP
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-7095
Mailing Address - Country:US
Mailing Address - Phone:985-727-4026
Mailing Address - Fax:
Practice Address - Street 1:215 SAINT ANN DRIVE
Practice Address - Street 2:SUITE 5
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3394
Practice Address - Country:US
Practice Address - Phone:985-626-4807
Practice Address - Fax:985-626-3198
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist