Individual
BRENDA ROUSSEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3 BRIDGE ST, PHYSICAL THERAPY SUITE, CARTHAGE, NY 13619-1360
(315) 493-1395
(315) 493-1417
Mailing address
14500 BUSTLETON AVE, SUITE 1A, PHILADELPHIA, PA 19116-1188
(215) 613-6523
(215) 613-6527
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-13-15021
ZZ
Other
Enumeration date
03/24/2014
Last updated
03/24/2014
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