Provider Demographics
NPI:1861996118
Name:ROUX, CAMILLE HELENE (PT)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:HELENE
Last Name:ROUX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:H
Other - Last Name:HOUTMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8 OAKLAND ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1325
Mailing Address - Country:US
Mailing Address - Phone:617-301-2843
Mailing Address - Fax:
Practice Address - Street 1:388 PLEASANT ST STE 305
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-8143
Practice Address - Country:US
Practice Address - Phone:781-388-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist