Provider Demographics
NPI:1750564654
Name:ROUSSEAU-DENTON, ANNA ELIZABETH (PTA)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:ELIZABETH
Last Name:ROUSSEAU-DENTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:ELIZABETH
Other - Last Name:DENTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:1324 SW 118TH PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-4420
Mailing Address - Country:US
Mailing Address - Phone:405-691-7362
Mailing Address - Fax:
Practice Address - Street 1:2111 RIVERWALK DR
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2700
Practice Address - Country:US
Practice Address - Phone:405-793-7885
Practice Address - Fax:405-793-7893
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK73225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant