Healthcare Provider Details

I. General information

NPI: 1235022401
Provider Name (Legal Business Name): ALEXANDRIA DANIELLE ROUSSEAU DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 BEECH ST
HOLYOKE MA
01040-2223
US

IV. Provider business mailing address

35 ASSELIN ST
CHICOPEE MA
01020-3821
US

V. Phone/Fax

Practice location:
  • Phone: 413-534-2500
  • Fax:
Mailing address:
  • Phone: 413-386-4947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL81011
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: