Provider Demographics
NPI:1437124328
Name:ROUSSEAU, GERALD R (PT)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:R
Last Name:ROUSSEAU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:300 TOWER HILL RD
Mailing Address - Street 2:UNIT 128
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4814
Mailing Address - Country:US
Mailing Address - Phone:401-295-8500
Mailing Address - Fax:401-295-8536
Practice Address - Street 1:24 SALT POND RD
Practice Address - Street 2:H-5
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4314
Practice Address - Country:US
Practice Address - Phone:401-792-8500
Practice Address - Fax:401-792-8877
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RI1622225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
408399OtherBLUECHIP
408399OtherBLUECHIP