Provider Demographics
NPI:1184258584
Name:ROUSSEAU, PAMELA M (LMT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:M
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 MILLYARD STE 7
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2429
Mailing Address - Country:US
Mailing Address - Phone:978-808-9107
Mailing Address - Fax:
Practice Address - Street 1:26 MILLYARD STE 7
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2429
Practice Address - Country:US
Practice Address - Phone:978-808-9107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10676225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2774OtherLICENSE
MA10676OtherLICENSE