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General NPI Number Information
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NPI Number | 1164490439
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Entity Type | Individual
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Provider Name | PATRICIA ANNE ROULEAU PT, OCS
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Gender | Female
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 4720 CLEVELAND HEIGHTS BLVD SUITE 101
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City | LAKELAND
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State | FL
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Zip | 33813-2243
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Country | US
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Telephone | 863-644-0007
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Fax | 863-644-3377
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Provider Business Mailing Address
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Address Line | 4518 HALLAM HILL LANE
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City | LAKELAND
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State | FL
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Zip | 33813-1808
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Country | US
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Telephone | 863-644-0007
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Fax | 863-644-3377
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 10755
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License Number State | FL
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