Individual
MARY ROUSSEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
423 CORNELIA ST, BOONTON, NJ 07005-1804
(862) 579-8441
Mailing address
423 CORNELIA ST, BOONTON, NJ 07005-1804
(862) 579-8441
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
10/19/2015
Last updated
10/19/2015
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