MEDICARE: KRISTIN ROUSSEAU PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501013945	MI

General Provider Information

NPI Number	:	1265937718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN ROUSSEAU PT

Provider Business Mailing Address
First Line	:	4048 CEDAR BLUFF DR STE 2
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8895
Country	:	US
Telephone Number	:	231-347-9300
Fax Number	:	231-347-1613

Provider Business Practice Location Address
First Line	:	3805 S STRAITS HWY
Second Line	:
City	:	INDIAN RIVER
State	:	MI
Zip	:	49749-5146
Country	:	US
Telephone Number	:	231-238-4880
Fax Number	:	231-238-8777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	03/31/2026

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Directions to “ KRISTIN ROUSSEAU PT” Practice Location

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