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General NPI Number Information
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NPI Number | 1265937718
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Entity Type | Individual
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Provider Name | KRISTIN ROUSSEAU PT
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Gender | Female
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 20 OHLONE PKWY
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City | WATSONVILLE
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State | CA
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Zip | 95076-3767
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Country | US
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Telephone | 823-583-1724
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Fax |
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Provider Business Mailing Address
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Address Line | 20 OHLONE PKWY
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City | WATSONVILLE
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State | CA
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Zip | 95076-3767
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Country | US
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Telephone | 831-724-8235
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Fax |
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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 | 306350
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501013945
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License Number State | MI
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